The normal difference in bilateral indirect blood pressure recordings in normotensive individuals

Pesola, Gene R.; Pesola, Helen R.; Nelson, Michael J.; Westfal, Richard E.

doi:10.1053/ajem.2001.20021

Cited by 27 publications

(20 citation statements)

References 7 publications

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“…If both of these measurements had been excluded from the analysis, there would have been no significant systolic arm difference detected. The overall variability of 18% in greater than 10 mm Hg systolic blood pressure differences between arms is consistent with previous studies, [10][11][12][13][14] and indicates the degree of variability present in this unbiased blood pressure test.…”

Section: Discussionsupporting

confidence: 90%

“…[10][11][12][13][14] This difference of 10 mm Hg or more in systolic pressure between arms varies from 26% to 50% in studies with a mixture of normal and hypertensive individuals, 11,12 53% in patients seen in an ED with a multitude of diseases, 10 15% in a study of subjects with normal blood pressure, 14 and up to 8% in a study of patients with hypertension who had simultaneous indirect blood pressure recordings. 13 The primary purpose of this study was to clarify the normal variability in a blood pressure difference of greater than 10 mm Hg in subjects with hypertension.…”

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confidence: 99%

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The Normal Difference in Bilateral Indirect Blood Pressure Recordings in Hypertensive Individuals

Pesola¹,

Pesola²,

Lin³

et al. 2002

Acad Emergency Med

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Abstract. Objective:If there is a significant dichotomy between bilateral systolic blood pressure determinations in both arms in hypertensive individuals, it is often taken as a sign of underlying pathology. The primary objective was to determine what the normal variation might be for a significant difference between blood pressures in both arms. A clinically significant difference was chosen as a systolic blood pressure value greater than 10 mm Hg between the upper extremities, as is commonly quoted at the bedside and in the literature. Methods: Bilateral indirect blood pressure determinations were obtained in 100 subjects with hypertension in the sitting position. The blood pressure was obtained by two observers, one the recorder and the other who obtained the blood pressure but was blinded to the actual values taken. The order of blood pressure determination in the first arm was determined prior to the study from a table of random numbers. The coefficient of variation in obtaining the blood pressure in each arm was determined in 5 of the 100 subjects. The age, sex, and handedness of each individual were recorded as demographic variables. Results:The average left and right systolic blood pressures were 139 Ϯ 22 and 141 Ϯ 22 mm Hg, respectively. The average left and right diastolic blood pressures were 78 Ϯ 12 and 79 Ϯ 13 mm Hg, respectively. There was no significant difference between left minus right systolic or diastolic differences (paired t-test). There was no significant difference between systolic or diastolic blood pressures between gender or between left-and right-handed individuals (nonpaired t-test). The average coefficients of variation for taking right and left arm systolic pressures were 2.90% and 1.32%, respectively. Eighteen subjects (18%) had differences in systolic blood pressure between both arms exceeding 10 mm Hg (10% to 26%, 95% confidence interval). Conclusions: Differences of more than 10 mm Hg in indirect systolic blood pressure recordings between arms are frequent in asymptomatic hypertensive individuals and do not per se indicate any pathologic condition. In the right clinical situation, differences that are noted should be repeated and should be added to the total clinical picture when used to determine whether a pathologic condition is present. Assuming no significant aortic or subclavian disease in the population tested, the specificity of the bilateral blood pressure test was 82%.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

The Normal Difference in Bilateral Indirect Blood Pressure Recordings in Hypertensive Individuals

Pesola¹,

Pesola²,

Lin³

et al. 2002

Acad Emergency Med

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“…40,43 This study implies that a new threshold as low as ≥5 mmHg for a systolic IAD may be clinically important. Only this and the larger Vietnam experience study 8 have shown that an IAD ≥5 mmHg is associated with a survival difference.…”

Section: Comparison With Existing Literaturementioning

confidence: 88%

Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk

et al. 2016

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“…All BP measurements were taken on the left arm of the subject to eliminate differences between BP of the two arms. 19 Firstly, a BP reading was taken using a singleheaded stethoscope and a table-model mercury sphygmomanometer (Model ALPK2). It was ensured that the cuff fitted each subject well.…”

Section: Methodsmentioning

confidence: 99%

Validation of the Finometer device for measurement of blood pressure in black women

et al. 2004

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The improved Finapres apparatus, known as the Finometer, measures finger blood pressure noninvasively on a beat-to-beat basis and gives waveform measurements similar to intra-arterial recordings. The Finometer measures brachial pressure and corrects for finger pressure accordingly. It also corrects for the hydrostatic height of the finger with respect to the heart level. The objective was to validate the Finometer according to the revised British Hypertension Society (BHS) protocol and the criteria of the Association for the Advancement of Medical Instrumentation (AAMI). We carried out a main validation test using a subject group of 102 black women, which was also divided into smaller groups, namely 24 hypertensives, 25 obese normotensive and 35 lean normotensive women. Finometer and mercury sphygmomanometer blood pressure (BP) measurements were taken early in the morning before breakfast, after the subjects stayed overnight in a research unit. Within the whole subject group, the Finometer satisfied the AAMI criteria for accuracy and achieved an overall A/B grading according to the BHS criteria. The sphygmomanometer measurements were 128 7 20/ 78 7 12 mmHg compared to 130 7 20/78 7 11 mmHg for the Finometer. The average differences between the mercury sphygmomanometer and Finometer readings for systolic and diastolic BP were, respectively, À1.83 7 6.8 and 0.88 7 7.5. Systolic readings of the Finometer device differed by less than 5 mmHg for 64%, by less than 10 mmHg for 86% and differed by less than 15 mmHg for 96% of all readings. A total of 63% of all diastolic readings of the Finometer by less than 5 mmHg, 85% by less than 10 mmHg and 94% of all readings differed by less than 15 mmHg. On the basis of these results, the Finometer device satisfied the validation criteria of AAMI and received an A/B grading according to the BHS protocol. It can therefore be recommended for measurements in the clinical set-up and for research purposes.

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The normal difference in bilateral indirect blood pressure recordings in normotensive individuals

Cited by 27 publications

References 7 publications

The Normal Difference in Bilateral Indirect Blood Pressure Recordings in Hypertensive Individuals

The Normal Difference in Bilateral Indirect Blood Pressure Recordings in Hypertensive Individuals

Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk

Validation of the Finometer device for measurement of blood pressure in black women

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