BP Differences Between Arms Could be an Early Indicator of Serious Health Risks Ahead

SunTech has blogged on the importance of BP measurement in both arms before (see: Has My Physician Measured My BP in Both Arms?) and research articles continue to be published on this issue. But now, two new studies have been published showing that the benefits of BP measurement in both right and left arms could be a life saving step in routine care.

The first article, published in The Lancet, showed significant cardiovascular disease risk is detectable through identification of inter-arm differences in systolic blood pressure (SBP). In their research, Clark, et al (Jan 2012) reviewed and conducted a meta-analysis of 28 published studies that had examined specific vascular disease outcomes and mortality related to differences in SBP between arms. In the second publication, Clark, et al (Mar 2012) conducted a cohort study to determine if an inter-arm difference of SBP predicts future development of vascular disease or death.²

Both articles showed that SBP differences between arms of 15 mm Hg or more could help to identify a patient’s risk of vascular disease or mortality. At the very least, SBP differences between arms of 10 mm Hg or more, or 15 mm Hg or more “should prompt consideration of further vascular assessment and aggressive management of risk factors.”²

Current AHA guidelines recommend that BP measurement be taken in both arms at an initial office visit.³ Following the publication of these new findings, this recommendation will certainly gain more importance given the potential life saving benefits of its implementation.

We would like to know what you think about BP measurement in both arms. Have you had it done? Do you conduct dual arm measurements in your practice? Do you think these new studies will change how providers view the AHA recommendation to take BP measurements in both arms during initial office visits?

1. Clark, C.E., Taylor, R.S., Shore, A.C., Ukoumunne, O.C., & Campbell, J.L. (2012). The association of an inter-arm difference in systolic blood pressure with vascular disease and mortality: a systematic review and meta-analysis. The Lancet, 379(9819), 905-914. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61710-8/abstract*

2. Clark, C.E., Taylor, R.S., Shore, A.C., & Campbell, J.L. (2012). The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ, 344:e1327. http://www.bmj.com/content/344/bmj.e1327*

3. Pickering, T.G., Hall, J.E., Appel, L.J., Falkner, B.E., Graves, J., Hill, M.N., Jones, D.W., Kurtz, T., Sheps, S.G., & Roccella, E.J. (2005). Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation, 111: 697-716. http://circ.ahajournals.org/content/111/5/697.short *

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