Although different blood pressure readings between arms can be observed in various general populations, this difference may

be important in populations with an increased risk of cardiovascular disease. Infact the presence of a difference between arm measurements could lead to delayed diagnosis and poor control in hypertension. The approach of standardising measurement to the arm with the highest reading is failed (misled decisions about management). At the same time, if the guidelines highlight the need to check blood pressure in both arms, this practise is not followed by many clinicians, even if is well known (National Institute for Health and clinical Excellence) that, if interarm difference exceeds 20 mmHg, a vascular disease is possible. An evidence review for interarm differences in blood pressure was outside the remit of this update; however, it did not consider the group with an
interarm difference in systolic blood pressure of 10-20 mm Hg, despite our previous systematic review suggesting that this group represents 15% of the population

(strength). Previous works demonstrated that a significant interarm difference in systolic blood pressure increases mortality in people at higher risk of vascular disease
with hypertension.