Inter-arm differences in blood pressure: when are they clinically significant?

Lane, Deirdre A.; Beevers, M.; Barnes, Nicola; Bourne, James Thomas; John, Andrew St; Malins, Simon; Beevers, D. G.

doi:10.1097/00004872-200206000-00019

Cited by 168 publications

(180 citation statements)

References 23 publications

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“…Almost all have reported finding differences, but there is no clear pattern; thus, the difference does not appear to be determined by whether the subject is right-or left-handed. 94 One of the largest studies was conducted in 400 subjects using simultaneous measurements with oscillometric devices, which found no systematic differences between the 2 arms, but 20% of subjects had differences of Ͼ10 mm Hg. 94 Although these findings are disturbing, it is not clear to what extent the differences were consistent and reproducible, as opposed to being the result of inherent blood pressure variability.…”

Section: Differences Between the 2 Armsmentioning

confidence: 99%

“…94 One of the largest studies was conducted in 400 subjects using simultaneous measurements with oscillometric devices, which found no systematic differences between the 2 arms, but 20% of subjects had differences of Ͼ10 mm Hg. 94 Although these findings are disturbing, it is not clear to what extent the differences were consistent and reproducible, as opposed to being the result of inherent blood pressure variability. Nevertheless, it is recommended that blood pressure should be checked in both arms at the first examination.…”

Section: Differences Between the 2 Armsmentioning

confidence: 99%

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Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,053

963

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Abstract-Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.

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Section: Differences Between the 2 Armsmentioning

confidence: 99%

Section: Differences Between the 2 Armsmentioning

confidence: 99%

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,053

963

View full text Add to dashboard Cite

show abstract

“…35 But normal anatomy alone cannot explain the higher left arm pressures noted. 36,51 It is our contention that the IAD may be due Abbreviations: CI, confidence interval; dIAD, diastolic inter-arm difference; sIAD, systolic inter-arm difference.The inter-arm blood pressure difference CE Clark et al 926 …”

mentioning

confidence: 99%

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

et al. 2006

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A blood pressure (BP) difference between arms was first reported over 100 years ago. Knowledge of its prevalence and relevance to the accurate measurement of BP remains poor. Current hypertension guidelines do not emphasise it. The objectives of this study were to establish the best estimate of prevalence of the interarm difference (IAD) in the population, to consider its implications for accurate BP measurement and treatment, and to discuss its aetiology and potential as a risk marker for cardiovascular disease. Systematic literature review was carried out. The data sources were Medline EMBASE and CINAHL databases, and Index of Theses. Studies reporting prevalence rates of IAD were retrieved and considered for inclusion against explicit methodological criteria. Point prevalence rates were extracted and weighted mean prevalence rates calculated. The main outcome measures were weighted mean prevalences of systolic IADX10 and X20 mm Hg and of diastolic IADX10 mm Hg. Thirty-one studies were identified. Most had methodological weaknesses; only four met the inclusion criteria. Pooled prevalences of the IAD from these four studies were 19.6% systolic X10 mm Hg (95% CI 18.0-21.3%), 4.2% systolic X20 mm Hg (95% CI 3.4-5.1%) and 8.1% diastolic X10 mm Hg (95%CI 6.9-9.2%). In conclusion, an IAD is present in a substantial number of patients and should be looked for whenever diagnosis and treatment depend on accurate measurements of BP. The importance of an IAD should be better emphasised in current hypertension management guidelines. There is evidence associating an IAD with peripheral vascular disease, raising the possibility that its presence may predict cardiovascular events. IntroductionPatients are regularly encountered in the clinical setting with a different systolic or diastolic blood pressure (BP) in each arm. Comparisons of arm pressures have been made ever since the modern sphygmomanometer was introduced, 1 yet the significance of this finding, which Cyriax named the 'differential BP sign', 2 is still poorly appreciated today.Hypertension is one of the major causes of premature morbidity and mortality throughout the developed and developing worlds. 3 The vast majority of patients with hypertension are managed in primary care 4 and measurement of BP is the most common investigation performed in this setting. 5 The management of hypertension is known to be suboptimal; 6 therefore, knowledge of the latest guidelines, and the many factors known to influence readings, is crucial. 7 The prevalence of a systolic (sIAD) or a diastolic (dIAD) inter-arm difference, its importance for the management of hypertension, its significance as a potential marker of peripheral vascular disease (PVD) and predictor of cardiovascular disease (CVD) in hypertensive patients are the subjects of this review.Although recent ambulatory BP monitoring guidelines recommend routine bilateral assessment, 8 the latest British guidelines for the management of hypertension merely state that 'BP should initially be measured in both arms as patient...

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“…Finally, an interarm difference is commonly reported through literature, with consistently higher SBP values for the right arm than for the left [26][27][28]. A plausible reason for the right-left differences might be that most people are right handed and, therefore, have a larger muscle mass in the right arm that is less easily compressed by the blood pressure cuff [28].…”

Section: Discussionmentioning

confidence: 87%

Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

Atsma¹,

Bartelink²,

Grobbee³

et al. 2005

Journal of Clinical Epidemiology

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Background and Objective: To investigate which method of ankle-arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility.Study Design and Setting: In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated.Results: The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap.Conclusions: To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP. Ó

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Inter-arm differences in blood pressure: when are they clinically significant?

Cited by 168 publications

References 23 publications

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

Best reproducibility of the ankle–arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure

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