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Research

Inter-arm blood pressure difference and cardiovascular risk estimation in primary care

Sinead Teresa Jennifer McDonagh, Ben Norris, Jayne Fordham, Maria R Greenwood, Suzanne Richards, John Campbell and Christopher Clark
BJGP Open 6 April 2022; BJGPO.2021.0242. DOI: https://doi.org/10.3399/BJGPO.2021.0242
Sinead Teresa Jennifer McDonagh
1 Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine & Health, Smeall Building, St Luke’s Campus, Exeter, Devon, United Kingdom
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  • ORCID record for Sinead Teresa Jennifer McDonagh
Ben Norris
2 Amicus Health - Clare House Surgery, Tiverton, Devon, United Kingdom
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Jayne Fordham
3 Mid Devon Medical Practice, Witheridge Medical Centre, Tiverton, United Kingdom
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Maria R Greenwood
3 Mid Devon Medical Practice, Witheridge Medical Centre, Tiverton, United Kingdom
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Suzanne Richards
4 Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
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John Campbell
1 Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine & Health, Smeall Building, St Luke’s Campus, Exeter, Devon, United Kingdom
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Christopher Clark
1 Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine & Health, Smeall Building, St Luke’s Campus, Exeter, Devon, United Kingdom
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Abstract

Background Systolic inter-arm differences (IAD) in blood pressure (BP) contribute independently to cardiovascular risk estimates; this can be used to refine predicted risk and guide personalised interventions.

Aim To model the effect of accounting for IAD in cardiovascular risk estimation in a primary care population free of pre-existing cardiovascular disease.

Design and setting Cross-sectional analysis of people aged 40-75 years attending National Health Service (NHS) Health Checks in one general practice in England.

Method Simultaneous bilateral BP measurements were made during Health Checks. QRISK2, ASCVD and Framingham cardiovascular risk scores were calculated before and after adjustment for IAD using previously published hazard ratios. Reclassification across guideline-recommended intervention thresholds was analysed.

Results Data for 334 participants were analysed. Mean (standard deviation) QRISK2, ASCVD and Framingham scores were 8.0 (6.9), 6.9 (6.5) and 10.7 (8.1) respectively rising to 8.9 (7.7), 7.1 (6.7) and 11.2 (8.5) after adjustment for IAD. 13 (3.9%) participants were reclassified from below to above the 10% QRISK2 threshold, 3 (0.9%) for the ASCVD 10% threshold and 9 (2.7%) for the Framingham 15% threshold.

Conclusion Knowledge of IAD can be used to refine cardiovascular risk estimates in primary care. By accounting for IAD, recommendations of interventions for primary prevention of cardiovascular disease can be personalised and treatment offered to those at greater than average risk. When assessing elevated clinic BP readings, both arms should be measured to allow fuller estimation of cardiovascular risk.

  • blood pressure determination
  • hypertension
  • cardiovascular risk factors
  • primary health care
  • screening
  • Received December 22, 2021.
  • Revision received March 15, 2022.
  • Accepted April 4, 2022.
  • Copyright © 2022, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
Inter-arm blood pressure difference and cardiovascular risk estimation in primary care
Sinead Teresa Jennifer McDonagh, Ben Norris, Jayne Fordham, Maria R Greenwood, Suzanne Richards, John Campbell, Christopher Clark
BJGP Open 6 April 2022; BJGPO.2021.0242. DOI: 10.3399/BJGPO.2021.0242

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Accepted Manuscript
Inter-arm blood pressure difference and cardiovascular risk estimation in primary care
Sinead Teresa Jennifer McDonagh, Ben Norris, Jayne Fordham, Maria R Greenwood, Suzanne Richards, John Campbell, Christopher Clark
BJGP Open 6 April 2022; BJGPO.2021.0242. DOI: 10.3399/BJGPO.2021.0242
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Keywords

  • blood pressure determination
  • hypertension
  • cardiovascular risk factors
  • Primary Health Care
  • screening

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