Is the blood pressure the same in both arms?

Gould, Brian A.; Hornung, R. S.; Kieso, H; Altman, Douglas G.; Raftery, Edward B.

doi:10.1002/clc.4960080803

Cited by 45 publications

(32 citation statements)

References 7 publications

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“…26 Gould and coworkers used two cuffs and two observers and found no difference in blood pressure in either arm. 27 A major problem is the spontaneous variability of blood pressure, which can produce spurious differences between the two arms if only a few readings are used. 28 However, though the prevalence of an inter-arm difference of systolic pressure of 10 mmHg or more is approximately doubled when measuring sequentially, when using a manual instead of an automated device, or when performing only one blood pressure measurement instead of multiple ones, 8 other studies indicate that prevalence may be 20% in general and hypertensive populations if the gold-standard method of repeated simultaneous measurements -or even a pragmatic sequential measurement protocol -is used.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

Martin¹,

Holder²,

Hodgkinson³

et al. 2013

Br J Gen Pract

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BackgroundInter-arm difference in blood pressure of >10 mmHg is associated with peripheral vascular disease, but it is unclear how much of the difference in sequential right and left arm blood pressure measurements might be due to a 'white-coat' effect. AimTo use ambulatory blood pressure monitoring (ABPM) to better understand the clinical significance of inter-arm differences in blood pressure. Design and settingRetrospective study in a teaching hospital in Birmingham. MethodAnonymised clinical data collected from 784 patients attending a single hospital-based hypertension clinic were retrospectively analysed. Each participant had blood pressure measured sequentially in both arms, followed by ABPM over the subsequent 24 hours. ResultsData were available for 710 (91%) patients, of whom 39.3% (279) had a blood pressure difference of 10 mmHg or more between each arm. Compared to daytime systolic ABPM, the difference was 25.1 mmHg using the arm with the highest reading, but only 15.5 mmHg if the lower reading was taken (mean difference 9.6 mmHg (95% confidence interval [CI] = 9.0 mmHg to 10.3 mmHg)). However, differences between mean right (20.7 mmHg) or left (19.9 mmHg) arm blood pressure and daytime systolic ABPM were very similar. ConclusionCompared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure. As there is no significant difference in the extent of disparity with ABPM by left or right arm, this is unlikely to be due to arm dominance and may be due to the 'whitecoat' effect reducing blood pressure on repeated measurement. Where a large inter-arm blood pressure difference is detected with sequential measurement, healthcare professionals should re-measure the blood pressure in the original arm. KeywordsAmbulatory blood pressure; blood pressure monitoring; cardiovascular risk; white coat hypertension.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

Martin¹,

Holder²,

Hodgkinson³

et al. 2013

Br J Gen Pract

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show abstract

“…This was shown by Harrison, 14 whose figure of 26% of patients with sequential inter-arm differences of Ͼ10 mm Hg dropped to 5.3% when simultaneous readings were taken with cuffs joined by a T-tube. Similarly, Gould 15 used two cuffs and two observers and found no systematic difference. In all the literature however, the intriguing fact remains that whenever an inter-arm difference is found, it is always the right being greater than the left.…”

Section: Discussionmentioning

confidence: 87%

A study of inter-arm blood pressure differences in primary care

Cassidy

Jones

2001

J Hum Hypertens

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Objectives: To investigate whether there are inter-arm blood pressure differences that are of clinical importance to general practice. Design and setting: Pragmatic study with randomised order of use of left or right arm carried out in routine surgeries in an inner city and suburban general practice. Subjects: There were 237 patients presenting opportunistically for blood pressure measurement to a nurse or general practitioner. Main outcome measures: 95% limits of agreement between measurements on the left and right arm and bias between arms. Results: Large inter-arm blood pressure differences exist reflected in wide 95% limits of agreement; ؊16

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“…The choices of inclusion criteria were our own but based on a published critique 32 of the methodology of one of the studies. 46 Implications for BP measurement in practice Failure to recognise the IAD and to standardise readings to the higher arm runs the risks of inadequate treatment of hypertensive patients, false diagnosis of hypotension due to over treatment (pseudohypotension 36 ), a delay in the diagnosis of hypertension, 63 or physician confusion creating the potential for 'clinical inertia'. 64 The Health Survey of England states that 'if systolic BP were lowered by X10 mm Hg among the 71.5% of hypertensive subjects uncontrolled (in the survey), we estimate that 44000 fatal and nonfatal coronary events and 46000 fatal and nonfatal strokes could be prevented each year in England.'…”

Section: Strengths and Weaknesses Of The Reviewmentioning

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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Is the blood pressure the same in both arms?

Cited by 45 publications

References 7 publications

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

A study of inter-arm blood pressure differences in primary care

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

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