Family Practice Vol. 19, No. 5, 439-441
© Oxford University Press 2002
The differential blood pressure sign in general practice: prevalence and prognostic value
The Mid Devon Medical Practice, School Surgery, Fore Street, Witheridge, Devon EX16 8AH and
a Research & Development Support Unit, School of Postgraduate Medicine and Health Sciences, Noy Scott House, Haldon View Terrace, Exeter EX2 5EQ, UK.
Dr CE Clark; E-mail: Chris.Clark{at}gp-L83023.nhs.uk
Background. Patients sometimes have differences of 
20/10 mmHg in their blood pressure depending on which arm is measured. The prevalence and prognostic value of this finding in general practice are unknown. If these differences are due to peripheral vascular disease, these patients may be at increased risk of cardiovascular or cerebrovascular events.
Objective. Our aim was to establish the frequency and prognostic value of a blood pressure difference between arms in one rural general practice.
Methods. Paired blood pressure readings were collected from patients attending the surgery. The outcome measures of myocardial infarction, new diagnosis of angina, a cerebrovascular event or death were recorded prospectively.
Results. A total of 280 patients were examined, and of these 13.6% had a systolic blood pressure difference (SBPD) of 20 mmHg, and 23.2% a diastolic blood pressure difference (DBPD) of 10 mmHg. Eighty-three patients were followed-up for 5.6 years. Patients with a DBPD of 10 mmHg showed a mean event-free survival of 3.3 years [95% confidence interval (CI) 2.2–4.4] compared with 5.0 years (95% CI 4.7–5.3) for those with a DBPD of <10 mmHg (P < 0.0001). Patients with an SBPD of 20 mmHg showed a mean event-free survival of 3.5 years (95% CI 2.3–4.7) compared with 4.9 years (95% CI 4.5–5.2) for an SBPD of <20 mmHg (P = 0.043).
Conclusions. During a single assessment of blood pressure, there will be a minority of patients with a difference of 20/10 mmHg between their right and left arms. Measurement of both arms is therefore necessary to diagnose and treat hypertension accurately. This study suggests an association between blood pressure difference and increased morbidity and mortality. Priority should be given to managing other risk factors aggressively in those patients with a reproducible blood pressure difference of 20/10 mmHg.
Keywords. Blood pressure measurement, general practice, hypertension.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. Agarwal Response to Prognostic Significance of Between-Arm Blood Pressure Differences: Between-Arm Blood Pressure Difference and Mortality and the Interarm Blood Pressure Difference: Between-Arm Blood Pressure Differences Are Important Hypertension, August 1, 2008; 52(2): e16 - e17. [Full Text] [PDF]
|
|
|
|
|
|
C. E. Clark and J. L. Campbell The Interarm Blood Pressure Difference Hypertension, August 1, 2008; 52(2): e15 - e15. [Full Text] [PDF]
|
|
|
|
 |
|
 C. E Clark, J. L Campbell, R. J Powell, and J. F Thompson The inter-arm blood pressure difference and peripheral vascular disease: cross-sectional study Fam. Pract., October 1, 2007; 24(5): 420 - 426. [Abstract] [Full Text] [PDF]
|
|