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. 2012 Mar 20:344:e1327.
doi: 10.1136/bmj.e1327.

The difference in blood pressure readings between arms and survival: primary care cohort study

Christopher E Clark  1 , Rod S Taylor, Angela C Shore, John L Campbell
Affiliations

The difference in blood pressure readings between arms and survival: primary care cohort study

Christopher E Clark et al. BMJ. .

Abstract

Objective: To determine whether a difference in systolic blood pressure readings between arms can predict a reduced event free survival after 10 years.

Design: Cohort study.

Setting: Rural general practice in Devon, United Kingdom.

Participants: 230 people receiving treatment for hypertension in primary care.

Intervention: Bilateral blood pressure measurements recorded at three successive surgery attendances.

Main outcome measures: Cardiovascular events and deaths from all causes during a median follow-up of 9.8 years.

Results: At recruitment 24% (55/230) of participants had a mean interarm difference in systolic blood pressure of 10 mm Hg or more and 9% (21/230) of 15 mm Hg or more; these differences were associated with an increased risk of all cause mortality (adjusted hazard ratio 3.6, 95% confidence interval 2.0 to 6.5 and 3.1, 1.6 to 6.0, respectively). The risk of death was also increased in 183 participants without pre-existing cardiovascular disease with an interarm difference in systolic blood pressure of 10 mm Hg or more or 15 mm Hg or more (2.6, 1.4 to 4.8 and 2.7, 1.3 to 5.4). An interarm difference in diastolic blood pressure of 10 mm Hg or more was weakly associated with an increased risk of cardiovascular events or death.

Conclusions: Differences in systolic blood pressure between arms can predict an increased risk of cardiovascular events and all cause mortality over 10 years in people with hypertension. This difference could be a valuable indicator of increased cardiovascular risk. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow of participants through study
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Fig 2 Distribution of interarm difference (mean of right arm minus mean of left arm) in systolic blood pressure (SBP) in study sample of 230 people with hypertension
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Fig 3 Kaplan-Meier plot for all cause mortality in 230 people with hypertension with or without an interarm difference in systolic blood pressure (SBP) of ≥10 mm Hg
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Fig 4 Kaplan-Meier plot for all cause mortality in 183 people with hypertension without cardiovascular disease at recruitment, with or without an interarm difference in systolic blood pressure (SBP) of ≥10 mm Hg
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Fig 5 Kaplan-Meier survival curve for fatal and non-fatal events stratified by pre-existing cardiovascular disease (CVD) at recruitment, cardiovascular risk score, and interarm difference in systolic blood pressure (SBP) ≥10 mm Hg (n=230)
See this image and copyright information in PMC

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References

    1. Clark CE, Campbell JL, Evans PH, Millward A. Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review. J Hum Hypertens 2006;20:923-31. - PubMed
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    1. Clark CE, Powell RJ, Campbell JL. The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study. J Hum Hypertens 2007;21:633-6. - PubMed

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