Recommendations on blood pressure measurement.

Petrie, J C; O'Brien, E T; Littler, W. A.; Swiet, Michael de

doi:10.1136/bmj.293.6547.611

Cited by 363 publications

(186 citation statements)

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“…The arm with the higher values should be used for subsequent measurements '. 9 This appears to be guidance repeated almost verbatim through previous versions [10][11][12][13][14] stretching back over 60 years. 15 The guidelines do not consider the prevalence of the IAD and suggest that differences X20 mm Hg systolic and/or 10 mm Hg diastolic warrant specialist referral.…”

Section: Introductionmentioning

confidence: 82%

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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Section: Introductionmentioning

confidence: 82%

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

et al. 2006

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“…On the other hand, only one cuff size has been used for all individuals in the study and the length of 23 cm does not meet present recommendations of the AHA and BHS that a normal adultsized bladder should have at least dimensions of 13 × 24 cm and 12 × 26 cm respectively. 21,22 Although severe obese individuals were excluded, the availability of one cuff size might have affected measurements at the extremes of the arm circumference size. Considering that a bladder measuring 12 × 26 cm would correctly cuff 79% of European arms, 27 using a smaller bladder might have led us to overestimate the prevalence rates in our study.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy of eight aneroid sphygmomanometers used in the screening were checked at different pressure levels by connecting them with a metal T-connector to the tubing of a standardised mercury column manometer. 21, 22 The average of two readings was used to determine the BP level. The cuff size was 23 × 12.5 cm.…”

Section: Populationmentioning

confidence: 99%

The epidemiology of elevated blood pressure as an estimate for hypertension in Aydın, Turkey

Hm¹,

Başak²,

Camcı³

et al. 1999

J Hum Hypertens

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Background: Hypertension is an important public health problem, with some variability of its epidemiological properties in different populations. Objectives: The purpose of this study was to estimate the prevalence of hypertension and to determine the hypertension awareness, treatment and control rates in Aydın, a Turkish province. Methods: Of 1600 coincidentally selected people aged over 18 years in Aydın, 1480 (92.5%) had their blood pressure (BP) measured and answered a standard questionnaire in 1995. Results: Estimates of the prevalence of hypertension and its control were computed using two different criteria to define hypertension: BP у140/90 mm Hg or on treatment and BP у160/95 mm Hg or on treatment. Overall, the estimated prevalence of hypertension was 29.6%

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“…15 For the purposes of analysis the mean of the three recumbant blood pressure measurements was calculated. If blood pressure exceeded 210/120 mm Hg on two separate visits, the patient left the study to allow modification of medication, otherwise all concomitant antihypertensive medication was left unchanged for the duration of the study.…”

Section: Blood Pressure Measurementmentioning

confidence: 99%

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

et al. 2000

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The effects of hormone replacement therapy in hypertensive women are controversial. This randomised placebo controlled trial assessed the effect of tibolone 2.5 mg on blood pressure and fasting plasma lipids in 29 hypertensive postmenopausal women over 6 months using a 2:1 randomisation to tibolone. The primary clinical end-point was mean office blood pressure. At 6 months systolic blood pressure declined by 5.30 ؎ 2.87% vs 4.94 ؎ 3.37% whilst diastolic blood pressure declined 5.38 ؎ 2.65% vs 0.85 ؎ 3.69% on tibolone and placebo respectively. These differences were not statistically significant. Triglycerides decreased by 33.3 ؎ 6.1% vs 7.6 ؎ 7.9% (P Ͻ 0.01) and

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Recommendations on blood pressure measurement.

Cited by 363 publications

References 0 publications

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

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

The epidemiology of elevated blood pressure as an estimate for hypertension in Aydın, Turkey

A randomised placebo controlled trial of the effects of tibolone on blood pressure and lipids in hypertensive women

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