Inter‐Arm Blood Pressure Differences in Aviators: Is It Important?

Abstract

We read the article “Inter-Arm Blood Pressure Differences in Young, Healthy Patients” written by Grossman and colleagues1 with great interest. They concluded that there were no significant differences between right and left arm blood pressure (BP) measurements but inter-arm BP difference (IAD) was correlated with systolic BP. According to their results, significant IAD (>10 mm Hg) is common in young, healthy patients and so BP should be measured in both arms. We thank the authors for their contributions. The results of studies about the effects of IAD in young, healthy patients and aviators might be controversial. Currently, coronary risk factors, eg, hypertension, obesity, and diabetes, are increasing in prevalence among the young population.2 Higher systolic and diastolic BPs may be one of the features of excessive cardiovascular risk not only for older pilots but also young ones. Although all patients were completely healthy in the present study, the prevalence of IAD >10 mm Hg was 12.6% for systolic BP and 8.8% for diastolic BP and IAD was not correlated with age, body mass index, or heart rate, but was correlated with systolic BP. The impact of IAD during BP measurements has been the subject of extensive research in recent years. There may be a relationship between IAD and increased risk of cardiovascular morbidity in older patients.3 We do not know whether it is important in young patients, particularly cadet aviators. Additionally, measurement of BP must be very sensitive. While some centers can do it automatically, measurements are usually made manually. Therefore, analysis of intraobserver and interobserver differences are important. On the other hand, differential diagnosis of white-coat hypertension is a major concern, especially in young patients. The best way of excluding white-coat hypertension is 24-hour ambulatory BP monitoring in patients with higher BP measurements in the doctor's office.4 The measurement of BP in both the arms and legs is very important in cases of vascular disease such as peripheral vascular disease, aortic coarctation, and subclavian artery disease. The differences that exist in the values measured in both arms provide us with a diagnosis.5 The patient is important and we need further studies to better evaluate and understand BP measurements in both arms to exclude vascular disease and detect IAD.