Conflicting blood pressures worth checking, rechecking
At a routine follow-up at my doctor’s office, the nurse took my blood pressure on my left arm, and it was 143/73.
This seemed high, so I asked her to check it on my right arm. It was 104/62 on that arm.
She said she had never seen anything like that. Is there a logical explanation for this?
There are several reasons why blood pressure might measure differently in the arms, all with logical explanations.
The first to come to mind is not common in adults but one doctors are taught to look for: coarctation of the aorta.
This is a congenital heart defect involving a narrowing of the aorta (the main blood vessel that comes straight out of the left ventricle). It can occur in the area between where the blood vessels for the left and right arms originate.
The problem is usually found in children but sometimes can be missed until adulthood. However, because the right side originates closer to the heart than the left, the left side should have lower blood pressure.
A blockage in the artery going to the arm (there are three: the brachiocephalic, subclavian and brachial arteries; the larger ones, listed first, divide into the smaller ones) can reduce the blood pressure in one arm. An inflammatory disease of the blood vessel, Takayasu arteritis, can preferentially affect one limb, so it’s important to measure blood pressures in both arms and legs if concerned about this diagnosis.
However, it is prudent to be sure about the measurements before either getting worried or embarking on a search for these conditions. Blood pressure can change suddenly. I recommend carefully measuring it three times in each arm and comparing the average of each arm’s values against the other.
A difference of five to 10 points is normal; more than 10 is not normal.
In a recent column, a 63-year-old woman complained about her eyebrows starting to disappear at the outer edges. The same thing happened to me (I am about the same age). My blood tests were normal. I think for many, it’s simply aging. I disliked it so much that I tried Latisse, which many people use for eyelashes. One drop each night, and my eyebrows are back as if I were 20 again.
As an internist, I think about what skin, nail and hair problems might mean as far as diagnosing medical problems. Which is why I recommend evaluation of the thyroid gland — loss of the outer part of the eyebrow can be a clue to this important problem. But I also recognize that it can be a cosmetic issue, too.
Bimatoprost (Latisse) is a prescription medication indicated for people with decreased eyelash volume. I have found case reports and anecdotal evidence that it is effective for eyebrows, too. This is an off-label use of the medication. It is expensive, on the order of $140 a bottle, and might not be covered by insurance for this purpose. Any improvement in the eyebrows is likely to disappear when use of the product is discontinued.
— L.B. Answer: — A.K.M.