The Unilateral Measurement of Blood Pressure May Mask the Diagnosis or Delay the Effective Treatment of Hypertension

Abstract

Several studies have indicated the presence of significant interarm blood pressure (BP) differences; this could result in misclassification of BP status. Nevertheless, the findings of these studies were not consistent. This prospective, observational study investigated the presence and magnitude of interarm BP differences and determined the influence of age, gender, arm circumference, smoking, being hypertensive or diabetic, or having a previous history of cardiovascular disease in these differences. The study included 384 subjects, who were patients, ward visitors, and members of the nursing staff of this Department. BP measurements were recorded simultaneously in both arms by using 2 validated, fully automated oscillometric electronic devices. There were significant differences between the right arm and left arm systolic BP (p < 0.0005), between right arm and left arm diastolic BP (p < 0.05), and between right arm and left arm pulse pressure (p = 0.006). The mean interarm differences in systolic and diastolic BP measurements were 1.2 +/-5.0 mm Hg and 0.4 +/-4.2 mm Hg, respectively. There were 13 subjects (3.4%) and 4 subjects (1.04%) with an interarm systolic and diastolic BP difference of > 10 mm Hg, respectively, and a single patient with both interarm systolic and diastolic BP differences of > 10 mm Hg (0.26%). None of the studied demographic or clinical characteristics was a significant predictor of interarm systolic and diastolic BP differences. The authors conclude that significant interarm systolic and diastolic BP differences are frequently present. Therefore, the unilateral measurement of BP may mask the diagnosis or delay the effective treatment of hypertension. It is thus recommended that BP should be simultaneously measured in both arms at the initial consultation and the higher of the 2 readings should be used to guide further management decisions.

Interarm Blood Pressure Difference in People With Diabetes: Measurement and Vascular and Mortality Implications

“…The prevalences reported for control subjects were lower than those from the diabetic recruits. Reports using simultaneous repeated measures in unselected general populations have not previously been published; four studies, all of convenience samples drawn from hospital inpatients and outpatients and visitors provide the closest comparison (19)(20)(21)(22). The pooled prevalence of a systolic interarm difference $10 mmHg for these cohorts is 4.2% (3.0-5.3), which is comparable to the 2.9% control prevalence reported here.…”

Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis

“…Ten studies were not suitable for quantitative analysis (Appendix Table 2). 13,15,[29][30][31][32][33][34][35][36] Seventeen studies (18 cohorts) were included in the analysis. Five included cohorts 16,22,23,37 had prospective design, and remaining studies were cross-sectional in nature.…”

Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England

“…37 Only three-quarters of practices in which both arms are measured reported standardising subsequent readings to the higher reading arm. Use of British Journal of General Practice, May 2017 e311 the lower reading arm risks underdiagnosis and undertreatment of hypertension, 38,39 and failure to consider the associated cardiovascular risk of an inter-arm difference may prevent full consideration of personalised cardiovascular risk for individuals. 40,41 In 2011 NICE recommended that ABPM should be offered if a clinic blood pressure is ≥140/90 mmHg to minimise overdiagnosis of hypertension because of white-coat effects.…”