QuoteJustified reasonsReferencedMethod stated
UK guidelines
 BHS recommendations on BP measurement 1986BP should be measured in both arms in all patients with high BP at the initial assessment, and if a reproducible difference of 20 mmHg for systolic pressure and 10mmHg for diastolic pressure simultaneous measurements should be performedPartialNoNo
 BHS-1 1989
 BHS-2 1993, BHS-3 1999Not mentioned in text directly but refers to BHS recommendations on BP measurement 1986
 BHS-4 2004BP should initially be measured in both arms as patients may have large differences between armsPartialNoNo
 NICE 2006Measure blood pressure on both of the patient's armsNoNoNo
 MHRA 2006BP should initially be measured in both arms … A difference in BP between the arms can be expected in about 20% of patientsYesNoNo
 CKS library, 2007Initially, measure the BP in both arms, as there can be large differences between arms (greater than 10 mmHg)PartialNoNo
US and Canadian guidelines
 JNC-1 1977, JNC-2 1980
 JNC-3 1984, JNC-4 1988, JNC-5 1993, JNC-6 1997, JNC-7 2003The physical examination should include: an appropriate measurement of BP, with verification in the contralateral armNoNoNo
 AHA 1980On the initial examination, one should record the pressure in both armsNoNoNo
 Canadian hypertension education program 2007 and 2008BP should be taken in both arms on at least one visit.NoNoNo
New Zealand, Australian and Japanese guidelines
 Heart Foundation of Australia 2008At the patient's first BP assessment, measure the BP on both arms, thereafter, use the arm with the higher readingNoNoNo
 Heart Foundation of Australia 2004Measure BP on both arms at the first visit, particularly if there is evidence of peripheral vascular disease. A variation of up to 5 mmHg in BP between arms can be acceptableNoNoNo
 New Zealand Cardiovascular Guidelines 2005Not mentioned
 JSH 2003The BP difference between the arms must be evaluated. If a difference of BP between the arms is apparent, the BP should usually be measured with the arm that shows the higher BPNoNoNo
South African Guidelines
 Hypertension Guideline 2003, 2000All measurements should preferably be taken using the same armNoNoNo
 Hypertension guideline 1995Not mentioned
International guidelines
 WHO/ISH 1989 WHO/ISH 1999Measure the blood pressure in both arms on the first visit if there is evidence of peripheral vascular diseaseNoNoNo
 ESH-ESC practice guidelines 2007, ESH-ESC 2003Measure BP in both arms at first visit to detect possible differences due to peripheral vascular diseaseYesNoNo
 ESH 2003a recent study has shown significant differences in inter-arm differences for systolic and diastolic blood pressure, leading to the recommendation that bilateral measurement should be made on first consultation …YesNoNo
 EJCPR 2003At the initial visit, BP values from both arms should be obtained to detect patients in whom atherosclerotic plaques in subclavian or more central arteries may be responsible for substantial between-arm discrepanciesYesNoNo
  • Note: Justification has been italicised. AHA = American Heart Association; BHS = British Hypertension Society; BP = blood pressure; CKS = Clinical Knowledge Summaries; EJCPR = European Journal of Cardiovascular Prevention and Rehabilitation; ESC = European Society of Cardiology; ESH = European Society of Hypertension; JNC = Joint National Committee; MHRA = Medicines and Healthcare Products Regulatory Agency; JSH = Japanese Society of Hypertension; NICE: National Institute for Health and Clinical Excellence; WHO/ISH = World Health Organisation/International Society of Hypertension.