BP should be assessed simultaneously in both arms with with multiple readings

January 01, 0001

BP should be assessed simultaneously in both arms with with multiple readings

Screening for inter-arm difference (IAD) of blood pressure (BP) at each first visit is recommended by numerous guidelines whereas it is unclear whether the method by which IAD is measured has significant influence on the IAD value. A systematic review was made of the studies reporting on double- arm measurements and the association of IAD with procedure characteristics (Medline/PubMed, Embase, and Cochrane Library) by researchers from Chinese Taipei and The Netherlands.  

The mean absolute IAD was 5.4 and 3.6 mm Hg for systolic and diastolic BP, respectively. Of all subjects 14% had a systolic IAD greater than or equal to 10 mm Hg, 4% a systolic IAD greater than or equal to 20 mm Hg, and 7% a diastolic IAD greater than or equal to 10 mm Hg. The relative risk (RR) of obtaining a systolic IAD greater than or equal to 10 and 20 mm Hg and a diastolic IAD greater than or equal to 10 mm Hg is higher when measuring sequentially instead of simultaneously (2.2, 4.8 and 2.5 respectively), when using a manual instead of an automated device (2.1, 4.4 and 3.7 respectively) and when performing only one BP measurement instead of multiple (2.0, 4.3 and 4.4, respectively).

The researchers concluded: "Screening for IAD of BP is important but the measurement methodology has a major influence on IAD results. To prevent overestimation and observer bias IAD should be assessed simultaneously at both arms, with one or two automatic devices and multiple readings should be taken."

I feel a device coming on.


For the full abstract, click here.

American Journal of Hypertension published online 21 July 2011 © 2011, Rights Managed by Nature Publishing Group
Blood Pressure Measurement Method and Inter-Arm Differences: A Meta-Analysis. Willem J. Verberk, Alfons G.H. Kessels and Theo Thien. Correspondence to Willem Verberk: [email protected]

Category: K. Circulatory. Keywords: automatic oscillometric device, blood pressure, blood pressure measurement, double-arm measurements, hypertension, inter-arm difference, simultaneous measurements, meta-analysis, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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