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A study of inter-arm blood pressure differences in primary care

Journal of Human Hypertension volume 15, pages 519–522 (2001)Cite this article

Abstract

Objectives: To investigate whether there are inter-arm blood pressure differences that are of clinical importance to general practice.

Design and setting: Pragmatic study with randomised order of use of left or right arm carried out in routine surgeries in an inner city and suburban general practice.

Subjects: There were 237 patients presenting opportunistically for blood pressure measurement to a nurse or general practitioner.

Main outcome measures: 95% limits of agreement between measurements on the left and right arm and bias between arms.

Results: Large inter-arm blood pressure differences exist reflected in wide 95% limits of agreement; −16 mm Hg to 24 mm Hg for the right minus the left arm diastolic blood pressure. There is a small but statistically significant bias to the right arm blood pressure measuring higher than the left (3.7 mm Hg diastolic, 2.4 to 5 mm Hg 95% confidence intervals). An interarm difference of 10 mm Hg or greater for diastolic blood pressure occurred in 40% of subjects and a difference of 20 mm Hg or more for systolic blood pressure occurred in 23% of subjects.

Conclusions: In a primary care setting blood pressure should be measured routinely in both arms. If one arm is to be preferred for pragmatic clinical purposes, then this should be the right arm.

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References

  1. Osler W Modern Medicine, Volume 4 Lea & Febiger: Philadelphia 1915 p 498

    Google Scholar 

  2. Swaleset al Treating mild hypertension BMJ 1989 298 694–698

    Article  Google Scholar 

  3. Ramsay LE et alGuidelines for management of hypertension J Hum Hypertens 1999 13 569–592

    Article  CAS  Google Scholar 

  4. O’Brien E et alUse and interpretation of ambulatory blood pressure monitoring BMJ 2000 320 1128–1134

    Article  Google Scholar 

  5. Aylett M Pressure for change: unresolved issues in blood pressure measurement Br J Gen Pract 1999 49 136–139

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Swallow RA Hypertension which arm Br Med J 1975 3 370

    Article  CAS  Google Scholar 

  7. Altman DG How large a sample Br Med J 1980 281 1336–1338

    Article  CAS  Google Scholar 

  8. Hawthorne VM Blood pressure in a Scottish town Br Med J 1974 3 600–603

    Article  CAS  Google Scholar 

  9. Bland JM, Altman D Statistical methods for assessing agreement between two methods of clinical measurement Lancet 1986 8476 307–310

    Article  Google Scholar 

  10. Shock NW The differences between blood pressure measurements obtained simultaneously on the two arms Q J Exp Physiol 1940 30 155–162

    Article  Google Scholar 

  11. Southby R Some clinical observations on blood pressure and their practical application Med J Aust 1935 2 569–580

    Google Scholar 

  12. Amsterdam B Disparity in blood pressures in both arms in normals and hypertensives N Y State J Med 1943 43 2294–2300

    Google Scholar 

  13. Frank SM Right and left arm blood pressure discrepancies in vascular surgerypatients Anaesthesiology 1991 75 457–463

    Article  CAS  Google Scholar 

  14. Harrison BG Bilateral indirect and direct arterial pressures Circulation 1960 22 419–486

    Article  Google Scholar 

  15. Gould BA Is the blood pressure the same in both arms? Clin Cardiol 1985 8 423–426

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Sisters S Keir, L Hodgson L Fry and Drs M Sherratt, T Dowson and B Schumm for their work in data collection and the patients at Teams Family Practice and Fell Tower. Thanks to M Keir for statistical advice and Dr M Aylett for overall project advice.

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Authors and Affiliations

  1. Teams, Gateshead, Tyne and Wear, UK

    P Cassidy

  2. Newcastle University, Newcastle, UK

    K Jones

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  1. P Cassidy
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  2. K Jones
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Correspondence to P Cassidy.

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Cassidy, P., Jones, K. A study of inter-arm blood pressure differences in primary care. J Hum Hypertens 15, 519–522 (2001). https://doi.org/10.1038/sj.jhh.1001224

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  • DOI: https://doi.org/10.1038/sj.jhh.1001224

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