Simply measuring inter-arm systolic blood pressures (SBPs) can help you assess a patient’s risk of vascular disease or death

Most doctors know that identifying and treating patients with vascular disease can be difficult. A recent meta-analysis found that measuring inter-arm blood pressures can help you determine which patients are at greater risk for vascular disease or death.

Patients with a large inter-arm SBP difference need a vascular assessment, because they may develop more complex vascular disease. Those with inter-arm SBP differences of ≥10 mmHg are at greater[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] vascular disease risk and those with differences of ≥15 mmHg are at a greater risk of dying.


“Initial assessment of people with a higher risk of PVD such as smokers and diabetics should include blood pressure measurements of both arms.”
-Safraj Shahul Hameed, BDS, MSc, DPH, senior research fellow, Centre for Chronic Disease Control (CCDC), New Delhi, India


Key Point: Consider taking your patients’ blood pressure in both arms. Patients with inter-arm SBP differences of ≥10 mmHg or ≥15 mmHg need a vascular assessment due to their increased risk of vascular disease and death.

Safraj Shahul Hameed, BDS, MSc, DPH, senior research fellow, Centre for Chronic Disease Control (CCDC), New Delhi, India, said that the study has particular relevance for your patients since the latest estimates show that 26% of Indians suffer from uncontrolled hypertension. “This meta-analysis of 28 studies indicates that blood pressure measurements should be done in both arms and that differences could indicate increased risk of PVD,” Hameed told mdCurrent-India. “Initial assessment of people with a higher risk of PVD such as smokers and diabetics should include blood pressure measurements of both arms.”

Early detection essential

Many patients do not know that they have peripheral vascular disease (PVD), and PVD is a major risk factor for cardiovascular disease and death. When detected early, patients can make lifestyle changes to improve their health. You and your patients can work together to improve their vascular health through steps such as stopping smoking, improving diet, controlling diabetes, controlling high cholesterol, controlling blood pressure, decreasing obesity, exercising, and decreasing stress.

Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (HTN) and of the European Society of Cardiology advised in 2007 that arm SBP differences are due to PVD. Other studies have suggested that differences of more than 10 mmHg lead to poor patient results.

The authors of this study assessed the connection between inter-arm SBP differences and death, and central or peripheral vascular disease. In an invasive assessment using angiography for patients with more than 50% occlusion of the subclavian artery, there was a mean SBP difference of 37 mmHg. A difference of ≥10 mmHg was strongly linked to subclavian stenosis. This was both clinically and statistically significant (P<0.0001). In patients who were evaluated by non-invasive methods, a difference of ≥15 mmHg was associated with PVD, pre-existing cerebrovascular disease, increased cardiovascular mortality, and all-cause mortality. Differences of ≥10 mmHg were also linked to PVD.

Source: Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet Online January 30, 2012 DOI:10.1016/S0140-6736(11)61710-8.

Access the original journal information here:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961710-8/abstract
Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

[/s2If]

Log in or register for free to continue reading
Register Now For Free Already Registered? Log In
This entry was posted in Cardiology, Cardiovascular Disease, Hypertension, Primary Care and tagged , , , , , , , , . Volume: .

Post a Comment

You must be logged in to post a comment.