Differences in blood pressure between arms could indicate vascular risk

A systematic review and meta-analysis carried out by researchers at the University of Exeter Peninsula College of Medicine and Dentistry (PCMD), has found that differences in systolic blood pressure between arms could be a useful indicator of the likelihood of vascular risk and death.

The findings add support to the calls for both arm blood pressure checks to be performed as standard.

The review is published in The Lancet online and the study is supported by the Royal College of General Practitioners, the South West GP Trust and the National Institute for Health Research Peninsula Collaboration for Leadership in Applied Health Research and Care.

The study reviewed 28 papers covering difference in systolic blood pressure between arms. It found significant evidence to suggest that a difference of 15mm Hg or more was associated with increased risk of: peripheral vascular disease (the narrowing and hardening of the arteries that supply blood to the legs and feet); pre-existing cerebrovascular disease (affecting the blood supply to the brain and often associated with cognitive issues such as dementia); and mortality, both as a result of cardiovascular problems and generally.

The risk of peripheral vascular disease was also increased at a difference of 10mm Hg or more.

The findings further support the need for both arm blood pressure checks to be the norm – not least because most cases are ‘clinically silent’ and such checks would better identify those at risk.

Dr Christopher Clark, Clinical Academic Fellow at PCMD and a GP in Witheridge, Devon, led the study. He said:

‘Our findings indicate a strong association, and that differences of 10mm Hg or 15mm Hg or more might help to identify patients who are at risk and who need further vascular assessment.’

Although he cautioned that more studies are needed before these conclusions can apply usefully to clinical settings, Dr Clark will be flagging the results of the review to the UK Vascular Check programme.

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