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The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study

The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study Background. A blood pressure (BP) difference between the upper limbs is often encountered in primary care. Knowledge of its prevalence and importance in the accurate measurement of BP is poor, representing a source of error. Current hypertension guidelines do not emphasize this.Objectives. To establish the prevalence of an inter-arm blood pressure difference (IAD) and explore its association with other indicators of peripheral vascular disease (PVD) in a hypertensive primary care population.Methods. This was a cross-sectional study. Primary care, one rural general practice, was the setting of the study. The methods were controlled simultaneous measurement of brachial BPs, ankle-brachial pressure index (ABPI) and tiptoe stress testing in 94 subjects.Results. In all, 18 of 94 [19%, 95% confidence interval (CI) 1127%] subjects had mean systolic inter-arm difference (sIAD) 10 mmHg and seven of 94 (7%, 95% CI 212%) had mean diastolic inter-arm difference (dIAD) 10 mmHg. Nineteen of 91 (20%, 95% CI 1228%) had a reduced ABPI <0.9. There was negative correlation between systolic (Pearson's correlation coefficient 0.378; P 0.01) and diastolic (Pearson's correlation coefficient 0.225; P 0.05) magnitudes of IAD with ABPI. On tiptoe testing, 9/90 subjects (10%, 95% CI 416%) had a pressure drop 20%.Conclusions. An IAD and asymptomatic PVD are common in a primary care hypertensive population. Magnitude of the IAD is inversely correlated with ABPI, supporting the hypotheses that IADs are causally linked to PVD, and that IAD is a useful marker for the presence of PVD. Consequently, detection of an IAD should prompt the clinician to screen subjects for other signs of vascular disease and target them for aggressive cardiovascular risk factor modification. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Family Practice Oxford University Press

The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study

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References (39)

Publisher
Oxford University Press
Copyright
The Author 2007. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
ISSN
0263-2136
eISSN
1460-2229
DOI
10.1093/fampra/cmm035
pmid
17670807
Publisher site
See Article on Publisher Site

Abstract

Background. A blood pressure (BP) difference between the upper limbs is often encountered in primary care. Knowledge of its prevalence and importance in the accurate measurement of BP is poor, representing a source of error. Current hypertension guidelines do not emphasize this.Objectives. To establish the prevalence of an inter-arm blood pressure difference (IAD) and explore its association with other indicators of peripheral vascular disease (PVD) in a hypertensive primary care population.Methods. This was a cross-sectional study. Primary care, one rural general practice, was the setting of the study. The methods were controlled simultaneous measurement of brachial BPs, ankle-brachial pressure index (ABPI) and tiptoe stress testing in 94 subjects.Results. In all, 18 of 94 [19%, 95% confidence interval (CI) 1127%] subjects had mean systolic inter-arm difference (sIAD) 10 mmHg and seven of 94 (7%, 95% CI 212%) had mean diastolic inter-arm difference (dIAD) 10 mmHg. Nineteen of 91 (20%, 95% CI 1228%) had a reduced ABPI <0.9. There was negative correlation between systolic (Pearson's correlation coefficient 0.378; P 0.01) and diastolic (Pearson's correlation coefficient 0.225; P 0.05) magnitudes of IAD with ABPI. On tiptoe testing, 9/90 subjects (10%, 95% CI 416%) had a pressure drop 20%.Conclusions. An IAD and asymptomatic PVD are common in a primary care hypertensive population. Magnitude of the IAD is inversely correlated with ABPI, supporting the hypotheses that IADs are causally linked to PVD, and that IAD is a useful marker for the presence of PVD. Consequently, detection of an IAD should prompt the clinician to screen subjects for other signs of vascular disease and target them for aggressive cardiovascular risk factor modification.

Journal

Family Practice – Oxford University Press

Published: Aug 1, 2007

Keywords: Hypertension inter-arm difference peripheral vascular disease

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