Blood pressure difference between arms flags vascular disease
- From: Susan <susan@xxxxxxxxxxxx>
- Date: Thu, 02 Feb 2012 11:10:06 -0500
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http://www.internalmedicinenews.com/newsletter/the-impulse/singleview40941/blood-pressure-differences-between-arms-flags-vascular-disease/a2b3def3db.html
Blood Pressure Differences Between Arms Flags Vascular Disease
By: MARY ANN MOON, Internal Medicine News Digital Network
01/30/12
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FROM THE LANCET
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VITALS
Major Finding: A systolic BP difference of 15 mm Hg or more between a patient’s two arms signals a higher risk for peripheral vascular disease with a low sensitivity (less than10%) but a very high specificity (greater than 90%).
Data Source: A meta-analysis of 20 studies examining factors that correlated with small differences (10-15 mm Hg) in systolic BP between patients’ two arms.
Disclosures: This study was funded by the Royal College of General Practitioners, the South West GP Trust, and the Peninsula Collaboration for Leadership in Applied Health Research and Care. The investigators reported that they had no relevant financial disclosures.
A difference of 15 mm Hg or more in systolic blood pressure between a patient’s arms may signal the presence of asymptomatic peripheral vascular disease, according to a meta-analysis published online Jan. 30 in the Lancet.
Patients with this finding on physical examination might benefit from further assessment for peripheral vascular disease, much as those found to have reduced ankle-brachial pressure do. But simultaneous measurement of systolic BP in both arms is more easily done in the primary care setting, since such measurement in one arm is already routine and doesn’t require the time, experience, and training necessary for ankle-brachial pressure assessment, said Dr. Christopher E. Clark of the institute of health services research, University of Exeter (England), and his associates.
©Dr. Heinz Linke/iStockphoto.com
A meta-analysis showed that systolic blood pressure difference between a patient’s arms could mean there is asymptomatic peripheral vascular disease.
The most recent National Institute for Health and Clinical Excellence (NICE)guideline for hypertensionstates that a difference of 20 mm Hg or more between the arms is "unusual" and is often associated with underlying vascular disease, but doesn’t address smaller differences. The guideline also has advised routinely checking BP in both arms for several years, but most primary care physicians in the United Kingdom do not follow that advice, Dr. Clark and his colleagues said.
To establish whether small differences (10-15 mm Hg) in systolic blood pressure between the arms is associated with peripheral or cardiovascular disease, they performed a meta-analysis of 20 studies addressing the issue.
The investigators found that a difference of 10-15 mm Hg occurred in 12%-15% of the study subjects and was associated with peripheral vascular disease, with a low sensitivity but a very high specificity. This overall prevalence corresponds to published estimates in community studies, implying that findings of the meta-analysis are generalizable, they noted.
In particular, five studies that correlated systolic BP with findings on invasive angiography showed that a difference of 10 mm Hg or more was strongly associated with subclavian stenosis on the side with the lowest pressure (Lancet 2012 Jan. 30 [doi:10.1016/S0140-6736(11)61710-8]).
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