Physical Exam

Blood Pressure

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Video coming September 2026

How to Perform

Have the patient sit quietly for about 5 minutes with the back supported, legs uncrossed, and feet flat; bare the upper arm and support it at heart level. Choose a cuff whose bladder encircles roughly 80% of the arm and wrap it over the brachial artery. Palpate the brachial or radial pulse while inflating, and inflate to about 30 mmHg above the point where the pulse disappears. Place the stethoscope over the brachial artery and deflate slowly (about 2–3 mmHg per second). Record the pressure at the first appearance of repetitive tapping sounds (Korotkoff phase I, systolic) and at the point where the sounds disappear (phase V, diastolic).

How to Interpret

Acute Aortic Dissection

Inter-arm systolic blood pressure differential >=10 mmHg measured

Rule in

Helpful

Rule out

Somewhat helpful

Evidence:Limited

Aortic Regurgitation

Wide pulse pressure (systolic minus diastolic BP >60 mmHg, often with diastolic <60 mmHg and isolated systolic hypertension) in chronic moderate-to-severe aortic regurgitation

Rule in

Very helpful

Rule out

—

Evidence:Limited

Low-output State (Low Cardiac Index) Within Established Chronic Heart Failure

Proportional pulse pressure <=25% (pulse pressure divided by systolic BP <=0.25), measured

Rule in

Helpful

Rule out

Helpful

Evidence:Limited

Subclavian Artery Stenosis

Persistent inter-arm systolic blood pressure difference >=10 mmHg measured

Rule in

Helpful

Rule out

Somewhat helpful

Evidence:Limited

Volume Depletion From Significant Blood Loss

Postural pulse increment >=30 bpm OR severe postural dizziness (composite criterion)

Rule in

Very helpful

Rule out

Very helpful

Evidence:Limited

References

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Zhou Q, Huang S. The Predictive Value of Inter Arm Blood Pressure Difference, Inter Leg Blood Pressure Difference and Ankle Brachial Index for Acute Aortic Dissection. Rev Cardiovasc Med. 2023;24(1):009. doi:10.31083/j.rcm2401009. PMC11270447 (open access, CC BY 4.0). First author Zhou Q (not Liu).
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Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127-e248. Brathwaite L, Reif M. Hypertensive Emergencies: A Review of Common Presentations and Treatment Options. Cardiol Clin. 2019;37(3):275-286.
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Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. PMID: 26903338.
Wayne EJ. Clinical and metabolic studies in thyroid disease. Br Med J. 1960;1(5166):78-90. (Original Wayne Thyrotoxicosis Diagnostic Index; PMID 13843211.)
Vyas N, Hendren S, Sehgal DM, et al. The Accuracy of Physical Examination to Diagnose Anemia Among Patients Five Years or Older: A Systematic Review. Indian J Hematol Blood Transfus. 2023;39(1):90-101. doi:10.1007/s12288-022-01543-z. PMID: 36699436.
Choudhry NK, Etchells EE. Does this patient have aortic regurgitation? JAMA. 1999;281(23):2231-2238. PMID 10376577.
Etchells E, Bell C, Robb K. Does this patient have an abnormal systolic murmur? JAMA. 1997;277(7):564-571. doi:10.1001/jama.1997.03540310062036. PMID: 9032164. (JAMA Rational Clinical Examination original article. Structured MEDLINE search, two-observer methodologic grading. Full PDF behind JAMA Network paywall; AMA membership renewal pending.) Etchells E, Glenns V, Shadowitz S, Bell C, Siu S. A bedside clinical prediction rule for detecting moderate or severe aortic stenosis. J Gen Intern Med. 1998;13(10):699-704. doi:10.1046/j.1525-1497.1998.00207.x. PMID: 9798818. (Open access via PMC1500900.) Shellenberger RA, Crass S, Jevicks J, Badhwar A, Albright J, Kumar A. Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis. CJC Open. 2023;5(5):373-379. doi:10.1016/j.cjco.2023.02.007. PMID: 37377515. PMC10290951 (open access). PROSPERO registration CRD42022312606.
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