The normal range for inter-arm differences in blood pressure

Orme, Steve; Ralph, Somerfield; Birchall, Andrew; Lawson-Matthew, P J; McLean, Kenneth A; Channer, KS

doi:10.1093/ageing/28.6.537

Cited by 66 publications

(77 citation statements)

References 6 publications

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“…4 However, the small difference in the magnitude of the absolute BPs between the right and left arms suggests that no systematic bias was introduced by this method, and this is in keeping with data from previously reported large series. 7,[20][21][22] Although there was good correlation of IADs between attendances, this study did not measure changes to the IAD over the follow-up period. Therefore, the impact of medication and risk factor modification on the IAD cannot be assessed.…”

Section: Discussionmentioning

confidence: 96%

The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study

2007

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Objectives of this study were to measure the prevalence of a difference in blood pressure (BP) between arms and determine whether a difference is associated with increased risk of cardiovascular events or death. A prospective cohort study of 247 patients with hypertension was undertaken in one rural general practice in England. The main outcome measures were mean difference in BP between arms and new episodes of myocardial infarction, cerebrovascular event, onset of angina or peripheral vascular disease or death. A total of 57/247 (23%) patients had a mean difference in systolic BP between arms of X10 mm Hg and 8/247 (3%) had a mean difference of X20 mm Hg. A total of 15/247 (6%) patients had a mean difference in diastolic BP between arms of X10 mm Hg. Survival analysis after 4.7 years (range 3.3-5.9) showed a shorter mean survival time without event or death for patients with a difference in systolic BP of X10 mm Hg compared with a difference of o10 mm Hg (3.7 (95% confidence interval, 3.2-4.2) versus 4.8 (4.6-5.1) years; Po0.001; hazard ratio 2.5 (1.5-4.2), P ¼ 0.001). Difference in systolic BP of X10 mm Hg between arms is common in this primary care population and is associated with a shorter survival time to death or new cardiovascular event. Detection of a difference between arms may identify hypertensive patients at increased risk of cardiovascular events. Such an approach would allow more effective targeting of resources in primary prevention strategies.

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Section: Discussionmentioning

confidence: 96%

The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study

2007

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“…[21][22][23][24][25]72 No study has set out to compare the prevalence of an IAD in patients with or without CHD; however, data extracted from one study meeting our inclusion criteria showed a significantly higher prevalence of sIADX10 mm Hg in patients with CVD than without (19.4 vs 2.7%; OR 4.34, 95% CI 2.09-9.04; Po0.0001). 52 Arteriosclerosis was also more common in subjects with an IAD in Kay and Gardner's study, 38 whereas although Singer and Hollander found no relationship between coronary risk factors and an IAD, they did find the mean sIAD to be significantly higher in patients with known coronary artery disease than without (14.5 vs 10.4 mm Hg; P ¼ 0.05). 55 Another smaller study reported higher prevalence of IAD in patients with PVD compared to both CHD patients and controls.…”

Section: Pathophysiology Of the Iadmentioning

confidence: 86%

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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“…[36][37][38][39][40][41] Studies looking specifically at left or right handedness have also failed to demonstrate an association with the higher-reading arm. 33,42 In the current study, blood pressures were recorded in a fixed sequence for anklebrachial index assessment, 18 which may account for the bias towards higher rightarm blood pressures observed through order effects.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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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The normal range for inter-arm differences in blood pressure

Cited by 66 publications

References 6 publications

The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study

The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study

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

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

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