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BP Mismatch Between Arms Signals Risk (CME/CE)
MedPageToday, 2012, which showed that the same interarm differences were associated with peripheral vascular disease, as well as cardiovascular and all-cause death.
"Thus, evidence supports the association of an interarm difference with existing peripheral vascular disease, and we propose that this accounts for the survival differences seen," Clark and colleagues wrote.
"Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care," they wrote, noting that such an approach is not widely used despite support in clinical guidelines, possibly related to a perception of a lack of evidence.
Clark and colleagues examined data from 230 patients treated for hypertension at a rural general practice in Devon, England, who were followed for a median of 9.8 years.
At baseline, 24% of the patients had an interarm difference in systolic blood pressure of 10 mm Hg or more and 9% had a difference of at least 15 mm Hg.
Interarm systolic blood pressure differences of 10 to 15 mm Hg were associated with roughly three- to four-fold greater risks of cardiovascular and cerebrovascular events, cardiovascular mortality, all-cause mortality, and the combination of events and mortality.
The relationships remained significant even when the analyses were restricted to patients without pre-existing cardiovascular disease.
For example, the hazard ratios for all-cause mortality were 2.6 for a 10-mm Hg difference and 2.7 for a 15-mm Hg difference.
"This would suggest that those with an interarm difference may justifiably require aggressive management along secondary prevention guidelines, such as the addition of statin therapy, and potentially by adding antiplatelet treatment to their care; a strategy that remains of unclear benefit in primary cardiovascular prevention," the authors wrote.
An interarm difference in diastolic blood pressure of 10 mm Hg or more was associated with greater risks of combined cardiovascular and cerebrovascular events (HR 3.8) and the combination of events and death (HR 3.3).
Clark and colleagues acknowledged that the study was limited by the lack of strict randomization in the order of arm measurement.