Inter-arm Blood Pressure Difference Research Articles

ASSA13-18-1 The Inter-Arm Diastolic Blood Pressure Difference After One Arm Ischemia: A New Approach to Assess Vascular Endothelia Function

Objective The ischemia can induce flow-mediated dilatation (FMD), it is unclear that whether the ischemia induces decline on blood pressure (BP) and inter arm BP difference (IAD), and is there a correlation between FMD and IAD. Methods This study enrolled 108 subjects. The bilateral BPs were simultaneously measured with two automatic BP measurement devices. The right brachial artery diameter (D) was measured by ultrasound technique. After the baseline diameter (D0) and BP (BP0) taking, the right brachial artery was occluded by cuff inflation for 5 minutes. Then the diameter was repeatedly measured 1(D1), 1.5 (D1.5) and 2 (D2) min, and the bilateral BPs were measured for 3times at 3 (BP3), 4 (BP4) and 5 (BP5) min after release of the occlusive cuff. The average of 3 ΔD values was recorded as post-ΔD, and the ratio of post-ΔD/D0 was calculated. The BP differences between left and right arms (BPl-r) at 4 time points were calculated respectively and the average of 3 post-ischemic BPl-r was recorded as post- BP l-r. Results At baseline, the inter-arm SBP or inter-arm DBP were similar. Right arm ischemia induced significant DBP decline in the right arm only (69.0 ± 12.5 vs 72.7 ± 11.9 mmHg, p Conclusions The post-ischemic inter-arm DBP difference may be a potential index for clinical evaluation of vascular endothelial function.

ASSA13-15-22 The Inter-Arm Blood Pressure Difference Induced by Transradial Coronary Intervention

Background and ObjectiveInter-arm blood pressure difference (IAD) indicates artery disease of arm. This study was to investigate whether the transradial coronary intervention (TRI) increases the prevalence of IAD.MethodsThis study enrolled...

Abstract P385: Arterial Stiffness and Contralateral Differences in Ankle Blood Pressure: The Atherosclerosis Risk in Communities (ARIC) Study

Background: A large inter-arm difference in brachial systolic blood pressure (SBP) (>10 or 15 mmHg) is strongly associated with elevated cardiovascular mortality. It is currently not known whether such contralateral differences in SBP occur in ankle blood pressure. Although contralateral differences in SBP have been attributed to peripheral vascular disease, physiologic factors such as arterial stiffness could also be at play. Accordingly, the aims of this study were to assess the prevalence of brachial and ankle contralateral SBP differences in a sample of community dwelling older adults, and to determine whether this difference is associated with arterial stiffness. Methods: A total of 2,413 adults (39% male, mean age of 75 years) from the ARIC study with proper consent and non-missing outcomes were included, after excluding 968 subjects with arrhythmias (N=763), BMI >40 kg/m 2 (N=165), and missing covariates (N=40). The automatic vascular screening device was used to measure blood pressure simultaneously in the arms and ankles and to measure arterial stiffness by pulse wave velocity (PWV). PWV was assessed between the heart and ankle (haPWV), femoral artery and ankle (faPWV), and brachial artery and ankle (baPWV) in the right and left sides. The measurements were performed twice, and the results of the 2 readings were averaged. Multivariable logistic regression was used to examine characteristics associated with contralateral differences ≥15 mmHg in brachial and ≥12 mmHg in ankle SBP. Results: The mean±SD absolute contralateral differences in brachial and ankle SBP were 0.25±4.95 and 0.17±10.12 mmHg. Prevalences of inter-brachial SBP differences >10 and >15 mmHg were 6.4% and 0.9% respectively; the corresponding prevalences for inter-ankle SBP were 25.6% and 11.7%. Height, body weight, ankle brachial index (ABI), and level of SBP were associated with larger inter-brachial SBP differences. Age, body weight, ABI, and contralateral differences in haPWV, faPWV, and baPWV were related to inter-ankle SBP differences. Inter-ankle SBP differences were associated with contralateral differences of ≥100 cm/s in haPWV (OR=2.9 [95% CI=1.9-4.4]), ≥200 cm/sec in faPWV (OR=2.1 [95% CI=1.3-3.3]), and ≥250 cm/sec in baPWV (OR=2.8 [95% CI= 1.9-4.0]). The associations remained nominally significant after adjustment for age, gender, height, body weight, current smoking, SBP, and ABI. Conclusions: Inter-ankle differences in SBP of 10 mmHg or greater and 15 mmHg or greater are common in older adults, namely 25% and 12%, respectively. The magnitude of inter-ankle, but not inter-brachial, differences in SBP in older adults is associated with measures of local/regional vascular elasticity.

Interarm blood pressure difference and mortality in patients with acute ischemic stroke

The objective of this study was to assess the prognostic value of interarm difference of blood pressure (IAD) measured in acute ischemic stroke and to investigate its association with systemic atherosclerosis. This was a hospital-based retrospective observational study. Survival data and systolic/diastolic IAD were collected in patients with acute ischemic stroke. Systemic atherosclerosis was determined based on coronary CT angiography, transesophageal echocardiography, ankle-brachial index examination, and cerebral angiography covering both intracranial and extracranial cerebral arteries. Of 834 patients, 10.3% had a systolic IAD ≥ 10 mm Hg, and 6.0% had a diastolic IAD ≥ 10 mm Hg. During a mean follow-up period of 2.96 ± 0.95 years, 92 patients died (including 68 cardiovascular deaths). In multivariate Cox regression adjusted for cardiovascular risk factors and initial stroke severity, the presence of systolic IAD ≥ 10 mm Hg was associated with increased risk of all-cause mortality (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.16-3.35) and cardiovascular mortality (HR 2.49, 95% CI 1.39-4.46). Patients with diastolic IAD ≥ 10 mm Hg also had increased risk of all-cause mortality (HR 3.43, 95% CI 1.94-6.08) and cardiovascular mortality (HR 3.51, 95% CI 1.83-6.74). The presence of systolic or diastolic IAD ≥ 10 mm Hg was associated with peripheral artery disease in the lower limbs, but not with atherosclerosis in the cerebral artery, coronary artery, or the aorta. The presence of interarm systolic or diastolic blood pressure difference ≥ 10 mm Hg is a strong independent prognostic marker in acute ischemic stroke.

Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the ‘white-coat’ effect?

Inter-arm difference in blood pressure of >10 mmHg is associated with peripheral vascular disease, but it is unclear how much of the difference in sequential right and left arm blood pressure measurements might be due to a 'white-coat' effect. To use ambulatory blood pressure monitoring (ABPM) to better understand the clinical significance of inter-arm differences in blood pressure. Retrospective study in a teaching hospital in Birmingham. Anonymised clinical data collected from 784 patients attending a single hospital-based hypertension clinic were retrospectively analysed. Each participant had blood pressure measured sequentially in both arms, followed by ABPM over the subsequent 24 hours. Data were available for 710 (91%) patients, of whom 39.3% (279) had a blood pressure difference of 10 mmHg or more between each arm. Compared to daytime systolic ABPM, the difference was 25.1 mmHg using the arm with the highest reading, but only 15.5 mmHg if the lower reading was taken (mean difference 9.6 mmHg (95% confidence interval [CI] = 9.0 mmHg to 10.3 mmHg)). However, differences between mean right (20.7 mmHg) or left (19.9 mmHg) arm blood pressure and daytime systolic ABPM were very similar. Compared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure. As there is no significant difference in the extent of disparity with ABPM by left or right arm, this is unlikely to be due to arm dominance and may be due to the 'white-coat' effect reducing blood pressure on repeated measurement. Where a large inter-arm blood pressure difference is detected with sequential measurement, healthcare professionals should re-measure the blood pressure in the original arm.

Bilateral subclavian artery stenosis found by inter-arm blood pressure difference during distal pancreatectomy

Bilateral subclavian artery stenosis found by inter-arm blood pressure difference during distal pancreatectomy

Inter-arm Differences in Simultaneous Blood Pressure Measurements in Ambulatory Patients without Cardiovascular Diseases

BackgroundIt has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of < 5 mm Hg in simultaneous BP measurements. The purposes of this study is to examine whether there are between-arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences.MethodsWe examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|).ResultsThe mean absolute IAD in SBP and DBP were 3.19 ± 2.38 and 2.41 ± 1.59 mm Hg, respectively, in men and 2.61 ± 2.18 and 2.25 ± 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of ≤ 6 mm Hg, 98.1% with the IAD in SBP of ≤ 10 mm Hg, 96.5% with the IAD in DBP of ≤ 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of ≤ 6 mm Hg, 92.1% with IAD in DBP of ≤ 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function.ConclusionOur results showed that there were no significant between-arm differences in simultaneous BP measurements. It was also shown that most of the ambulatory patients without cardiovascular diseases had an IAD in SBP of < 10 mm Hg and an IAD in DBP of < 6 mm Hg.

Association of Inter-arm Blood Pressure Difference with Atherosclerosis in Patients without Cardiovascular Diseases

Received: 2013.5.14, Revised: 2013.9.23, Accepted: 2013.9.23 Correspondence to: Yun-Jin Kim, MD Address: Department of Family Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: +82-51-240-7834, Fax: +82-51-242-8671 E-mail: yujkim@pusan.ac.kr Blood pressure (BP) measurement is the most common investigation performed in primary care. Precise monitor of BP is important for early detection, treatment, prevention of hypertension. However, patients are often encountered in the clinical setting with a different systolic BP (SBP) or diastolic BP (DBP) in each arm. The presence of difference between arm BP can result in a delayed di❙Original Article❙ Vol. 19, No. 3, September 2013 ISSN 2233-8136, eISSN 2233-8454, http://dx.doi.org/10.5646/jksh.2013.19.3.71 Copyright 2013. The Korean Society of Hypertension c Association of Inter-arm Blood Pressure Difference with Atherosclerosis in Patients without Cardiovascular Diseases

Interarm Systolic BP Difference and Its Association With Cardiovascular Biomarkers and Biochemical Risk Factors

Interarm Systolic BP Difference and Its Association With Cardiovascular Biomarkers and Biochemical Risk Factors

387 Inter-Arm Blood Pressure Difference is Not Associated With High Ankle-Brachial Index

387 Inter-Arm Blood Pressure Difference is Not Associated With High Ankle-Brachial Index

Association of Interleg BP Difference with Overall and Cardiovascular Mortality in Hemodialysis

An interarm BP difference has been associated with atherosclerosis and adverse cardiovascular outcomes. This study investigated whether an interleg BP difference was associated with peripheral vascular disease and overall and cardiovascular mortality in hemodialysis patients. This study enrolled 210 hemodialysis patients from December 2006 to January 2007. Bilateral leg BPs were measured simultaneously by an ankle-brachial index (ABI)-form device before hemodialysis. The mean follow-up period was 4.4±1.5 years. ABI <0.9 and high brachial-ankle pulse wave velocity were independently associated with an interleg difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg. Furthermore, this difference was an independent predictor for overall mortality (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.68-6.72; P<0.01) and cardiovascular mortality (HR, 4.84; 95% CI, 1.84-12.71; P<0.01) after adjustment for demographic, clinical, and biochemical parameters. After further adjustment for ABI <0.9 and brachial-ankle pulse wave velocity, the relation remained significant to overall mortality (HR, 2.91; 95% CI, 1.28-6.64; P=0.01) and cardiovascular mortality (HR, 3.15; 95% CI, 1.05-9.44; P=0.04). A difference in systolic BP of ≥15 mmHg or diastolic BP of ≥10 mmHg between legs was associated with peripheral vascular disease and increased risk for overall and cardiovascular mortality in hemodialysis patients. Detection of an interleg BP difference may identify hemodialysis patients at increased risk of peripheral vascular disease and overall and cardiovascular mortality.

Simultaneous blood pressure measurement in both arms in hypertensive and nonhypertensive adult patients

When blood pressure (BP) is taken for the first time, it should be measured in both arms; follow-up measurements should be taken in the arm with the highest BP. However, in clinical practice, this recommendation is rarely followed. Identify the degree of differences in BP between the right and the left arm in individuals with normal and high BP. We measured BP in 111 hypertensive and 80 normotensive patients in both arms at the same time using identical Omron HEM 725 CIC automatic sphygmomanometers. The devices were then switched to the other arm and another set of readings was taken. The absolute and relative difference in BP between arms was calculated from the average of these two readings. We categorized differences as at least 5, at least 10, and at least 20 mmHg for systolic blood pressure/diastolic blood pressure (SBP/DBP). The BP was higher in the right arm, with no statistical significance. The relative differences were also not significant: SBP 1.1±7.1 and DBP 0.21±5.0. However, the absolute differences were significant at an individual level, with a systolic difference of 5.4±4.8 mmHg and a diastolic difference of 3.9 ±3.2 mmHg. The percentages of absolute SBP/DBP differences more than 5 mmHg (21.4%/20.4%) and more than 10 mmHg (15.7%/4.7%) were considerable. The range of arm differences was clinically significant; in hypertensives, the SBP/DBP was -13.2 to +15/-9.2 to +9.6 mmHg and in nonhypertensives it was -12.9 to +15.6/-9.7 to +10.1 mmHg. Although on average there was no clinically significant relative difference between arms, absolute differences at an individual level were often clinically significant. Failure to determine interarm BP differences will lead to erroneous clinical decisions.

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

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,...

Inter-arm blood pressure differences and Epicardial fat and metabolic syndrome in hypertensive patients

Inter-arm blood pressure differences and Epicardial fat and metabolic syndrome in hypertensive patients

One arm exercise induces significant inter-arm

ObjectivesThis study is designed to investigate the inducing effect of one-arm exercise on inter-arm blood pressure difference (IAD).Methods50 healthy young subjects were included in the study. 3 min exercises of...

173 Magnitude of Interarm Blood Pressure Difference in Inpatients with Hypertension and CKD

MAGNITUDE OF INTERARM BLOOD PRESSURE DIFFERENCE IN INPATIENTS WITH HYPERTENSION AND CKD Usman Lone, Hina M. Lone, Syed H. Mirzan, Veeraish Chauhan, Karthik Ranganna, Ziauddin Ahmed Drexel College of Medicine/Hahnemann University Hospital, Philadelphia, PA Hypertension guidelines, such as JNC 7, recommend that blood pressure (BP) be assessed in both arms at the initial visit. The goal of our study was to determine if there is a significant difference in interarm BP in hospitalized patients with history of hypertension at our institution, and if this difference was greater in those with CKD, as defined in this study by GFR less than 60ml/min by the MDRD formula. Charts of 94 hospitalized patients with history of hypertension were reviewed from a University Hospital. Data obtained included age, race, gender, GFR by MDRD formula, and BP measurements from both arms. BP was measured in a seated position with arm at heart level using DINAMAP blood pressure monitor. 40 patients (43%) had interarm SBP difference > 10mmHg, with mean 13.2± 2.0. Of these patients, 21(55%) had SBP greater in left arm and 17 patients (45%) had SBP greater in their right arm. Of the 94 patients, 34 patients (36%) had CKD and 21 of those patients (62%) had interarm SBP difference > 10mmHg (p 5mmHg was only noted in 27 patients (29%), mean 6.2±1.2. There was not a significant difference in interarm DBP in patients with and without CKD. In conclusion, our study shows that there is a difference in interarm SBP in patients with hypertension and the difference is significant in patients with CKD. It is not known which arm BP should used for continued assessment. More studies are needed to evaluate the cause and prognostic significance of such variation.

Interarm differences in blood pressure should be determinedby measuring both arms simultaneously withanautomatic oscillometric device

To compare two methods for screening interarm difference (IAD) of blood pressure. This study compared two methods for double-arm measurements: (i) conventional measurement (CM) and (ii) simultaneous automatic measurement (SAM). A total of 118 patients with two or more cardiovascular risk factors and a mean age of 59±17 years were referred to two internal clinics. CM was taken with a validated aneroid manometer in sitting position on the right and left arm subsequently and vice versa. SAM was taken three times in sitting position using a validated automatic oscillometric device equipped with two cuffs for simultaneous double-arm measurements. The average absolute IAD of the conventional systolic value (4.9 mmHg) was significantly higher than the average absolute IAD of the SAM pressures averaged from two (3.7 mmHg; P<0.03) and three measurements (3.8 mmHg; P<0.05). The standard deviations of IADs were significantly higher (P<0.05) for the conventional systolic and diastolic measurements (4.1/3.1 mmHg) than for SAM averaged from two and three (3.0/2.3 and 3.2/2.6 mmHg, respectively) measurements. Differences of more than 20 mmHg for systolic pressure and/or 10 mmHg for diastolic pressures averaged from two CMs, two SAMs, and three SAMs were seen in 10 (9%), four (3%), and six (5%) patients, respectively. SAM provides smaller and more reproducible IADs than CM and therefore, most likely better estimates a patient's true IAD.

Blood pressure measurement: One arm or both arm?

Guidelines for measuring blood pressure includes measurement of blood pressure on both arms but it is often ignored. Our case report aims at highlighting the need follow the guidelines. A 60 year old 59 kg weighing male asymptomatic patient without any comobidities was posted for bilateral inguinal hernia repair. The interarm blood pressure difference was discovered incidentally during his preanaesthetic evalution. On further evaluation patient was found to be having subclavian stenosis on left side which was asymptomatic. Intraoperative and post operative period was uneventful. Blood pressure measurement should be done in accordance with the stipulated guidelines. Inter arm blood pressure difference should be noted in all patients as not only for diagnosis and treatment of hypertension but also as a tool to diagnose asymptomatic peripheral vascular disesase.

Inter-arm blood pressure difference in type 2 diabetes: a barrier to effective management?

Previous studies have identified a substantial prevalence of a blood pressure difference between arms in various populations, but not patients with type 2 diabetes. Recognition of such a difference would be important as a potential cause of underestimation of blood pressure. To measure prevalence of an inter-arm blood pressure difference in patients with type 2 diabetes, and to estimate how frequently blood pressure measurements could be erroneously underestimated if an inter-arm difference is unrecognised. Cross-sectional study. Five surgeries covered by three general practices, Devon, England. Patients with type 2 diabetes underwent bilateral simultaneous blood pressure measurements using a validated protocol. Mean blood pressures were calculated for each arm to derive mean systolic and diastolic differences, and to estimate point prevalence of predefined magnitudes of difference. A total of 101 participants were recruited. Mean age was 66 years (standard deviation [SD] = 13.9 years); 59% were male, and mean blood pressure was 138/79 mmHg (SD = 15/10 mmHg). Ten participants (10%; 95% confidence interval [CI] = 4 to 16) had a systolic inter-arm difference > or =10 mmHg; 29 (29%; 95% CI = 20 to 38) had a diastolic difference >/=5 mmHg; and three (3%; 95% CI = 0 to 6) a diastolic difference > or =10 mmHg. No confounding variable was observed to account for the magnitude of an inter-arm difference. A systolic inter-arm difference > or =10 mmHg was observed in 10% of patients with diabetes. Failure to recognise this would misclassify half of these as normotensive rather than hypertensive using the lower-reading arm. New patients with type 2 diabetes should be screened for an inter-arm blood pressure difference.

Inter-arm Blood Pressure Differences in Pregnant Women

Poon, L. C.; Kametas, N.; Strobl, I.; Pachoumi, C.; Nicolaides, K. H. Author Information