1. Blood Pressure in Hemiparetic Arms
Amanda Rice, Roxanne Santiago, & Stefany Saura, 8West
Purpose: As neuroscience nurses working in a level one stroke center, we come across a
daily issue when monitoring blood pressures which can fluctuate between a hemiplegic
and non-hemiplegic arm. We found this to be a big concern regarding patient safety since
these results directly impact how we, as nurses, proceed with interventions such as drug
administration. The purpose of this project is to conduct a literature review to determine
how a hemiparetic extremity affects blood pressure.
Methods: We use search engines such as PubMed, EBSCOhost, and CINAHL that
contained the following words “blood pressure”,” stroke affected” , “hemiplegic”, and
“hemiparetic”’. Several 8West RNs were surveyed to ask what extremity they use when
measuring blood pressure.
Findings:
Yagi et. al invasively and noninvasively measured blood pressure in 47 patients after a
stroke, and found that the blood pressure was significantly higher in the paretic arm.
Furthermore, the circumference of the paretic arms in comparison to the working arms
was only slight, which did not influence the difference in blood pressure measurements
(Yagi et. al, 1986). Dewar et. al states that in 71% of the patients who had a spastic arm,
their blood pressure was higher. For patients who had a flaccid arm, the blood pressure
was lower. This study exemplified the influence of muscle tone in the affected arm by
either increasing or decreasing the blood pressure (Dewar et. al, 1992). Broe and Ofner
support this study by describing that there are vasomotor changes which affect the upper
extremities in patients after a stroke. These changes can affect the plegic arm, the non-
plegic arm, or both.
However, in a study done by Panayiotou et al., 47% of the patients with acute
hemiparesis and flaccidity had lower blood pressures in the paretic arm, and 53% of the
patients had higher blood pressures. This suggests that the best practice would be to
measure blood pressure in both arms to determine whether there is an interarm difference.
Interestingly, the American Heart Association performed a study that determine that
pulse oximetry is unchanged in the extremities of a hemiparetic patient, there is no
recommendation by the AHA on the placement of a blood pressure cuff. In addition,
they suggest placement of the oximetry probe on the affected side (Roffe et. al, 2001).
Recommendations: When reviewing the Duke Health policies, there are no guidelines
stating which extremity to monitor blood pressure. There is a lack of recent research and
evidence-based recommendations on which arm should be used for blood pressure
monitoring. We have concluded that it is best practice to use the non-affected arm for
blood pressure measurement. However, we also recommend that there be more research
completed to support our findings. We recommend that our unit have a presentation to be
shown during a meeting or an in-service to serve as a reminder of how to effectively take

2. blood pressure on the affected stroke arm.
Broe, G., & Ofner, F. (1970, May 30). Abnormal reflex cutaneous vasomotor response in
hemiplegics. Med J Aust, 1099-1102. PMID:5430488
Dewar, R., Sykes, D., Mulkerrin, E., Nicklason, F., Thomas, D., & Seymour, R. (1992).
The effect of hemiplegia on blood pressure measurement in the elderly. Postgraduate
Medical Journal, 68(805), 888–891. PMID: 1494509.
Panayiotou BN, Harper GD, Fotherby MD, Potter JF, Castleden CM. Interarm blood
pressure difference in acute hemiplegia. J Am Geriatr Soc. 1993 Apr;41(4):422-3. PMID:
8463530.
Roffe C, Sills S, Wilde K, Crome P. Effect of hemiparetic stroke on pulse oximetry
readings on the affected side. Stroke 2001; 32: 1808–10. PMID:11486109
Yagi, S., S. I., Y. T., & K. M. (1986, September 25). Blood Pressure in the Paretic Arms
of Patients with Stroke. New England Journal of Medicine N Engl J Med, 315(13), 836-
836. doi:10.1056/nejm198609253151318