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

BMJ2012;344:e1327

[Link to free full-text BMJ article PDF | PubMed ® abstract]

Research

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

Christopher E Clark, et al

Correspondence to: C E Clark christopher.clark@pms.ac.uk

[EXCERPTS]

Kaplan-Meier survival curve for fatal and non-fatal events stratified by pre-existing cardiovascular disease (CVD) at recruitment, cardiovascular risk score, and interarm difference in systolic blood pressure (SBP) ‰¥10 mm Hg (n=230)

Abstract

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, United Kingdom.

Participants 230 people receiving treatment for hypertension in primary care.

Intervention Bilateral blood pressure measurements recorded at three successive surgery attendances.

Main outcome measures Cardiovascular events and deaths from all causes during a median follow-up of 9.8 years.

Results At recruitment 24% (55/230) of participants had a mean interarm difference in systolic blood pressure of 10 mm Hg or more and 9% (21/230) of 15 mm Hg or more; these differences were associated with an increased risk of all cause mortality (adjusted hazard ratio 3.6, 95% confidence interval 2.0 to 6.5 and 3.1, 1.6 to 6.0, respectively). The risk of death was also increased in 183 participants without pre-existing cardiovascular disease with an interarm difference in systolic blood pressure of 10 mm Hg or more or 15 mm Hg or more (2.6, 1.4 to 4.8 and 2.7, 1.3 to 5.4). An interarm difference in diastolic blood pressure of 10 mm Hg or more was weakly associated with an increased risk of cardiovascular events or death.

Conclusions Differences in systolic blood pressure between arms can predict an increased risk of cardiovascular events and all cause mortality over 10 years in people with hypertension. This difference could be a valuable indicator of increased cardiovascular risk. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: https://creativecommons.org/licenses/by-nc/2.0/ and https://creativecommons.org/licenses/by-nc/2.0/legalcode.

© 2012 BMJ Publishing Group Ltd

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