Strong evidence from a large international study confirms that a difference in blood pressure readings between arms is associated with an increased risk for heart attack, stroke and death.
Led by the University of Exeter, the global INTERPRESS-IPD Collaboration meta-analyzed all available research, then combined data from 24 global studies to create a database of nearly 54,000 people . The data spanned adults from Europe, the USA, Africa and Asia where blood pressure readings for both arms were available.
Funded by the National Institute for Health Research (NIHR) and published today in Hypertension, the study is the first to conclude that the greater the interfacial blood pressure difference, the greater the additional health risk to the patient.
Currently, international blood pressure guidelines advise health professionals to measure blood pressure in each arm when assessing cardiovascular risk, – but this is widely ignored. The new study provides a new upper limit of ‘normal’ for arm difference in blood pressure, which is significantly lower than the current guidelines. The research could lead to a shift in international guidelines for hip-tolerance, meaning more at-risk patients could be identified and potentially life-saving treatments.
In a patient-centered approach, working with a patient advisory group at all stages of the study, the team analyzed data on inter-arm blood pressure difference, and found the number of deaths, heart attacks and strokes that occurred in the cohort over 10 years.
Lead author and GP Dr Chris Clark, from Exeter University School of Medicine, said: “Checking one arm then the other with a routine blood pressure monitor is cheap and can be done in any healthcare setting. no, no need for more or expensive equipment. Although international guidelines currently recommend that this be done, it will only occur about half the time at best, usually due to lack of time. Our research shows that the extra amount of time it takes to measure both arms could ultimately save lives. ”
“We have long known that a difference in blood pressure between the two arms is associated with worse health outcomes. The large numbers involved in the INTERPRESS-IPD study help us to understand this more clearly. It tells us that the higher the difference in blood pressure between arms, the greater the cardiovascular risk, so it is essential to measure both arms to determine which patients have patients who now need a blood pressure test should expect to have it checked in both arms, at least once. ”
Blood pressure rises and falls in a circle with each stroke. It is measured in units of millimeters of mercury (mmHg), and the reading is always given as two numbers: the high (systolic) reading represents the maximum blood pressure and is the lowest value (diastolic) is the lowest blood pressure. High systolic blood pressure indicates hypertension. It affects a third of adults and is the leading global cause of preventable heart attacks, strokes and deaths. A large difference between the systolic blood pressure measurements in both arms could be an indication that the arteries are narrowing, or becoming stiff, which may affect blood flow. These arterial changes are recognized as another risk marker for heart attack, stroke or early death, and should be examined for treatment.
The researchers concluded that each mmHg difference detected between the two arms was a 10-year projected risk that one of the following would occur by one percent; new angina, heart attack or stroke.
Currently, both UK and European guidelines recognize a systolic difference of 15 mmHg or more between the two arms as the threshold indicating additional cardiovascular risk. This new study found that a lower threshold of 10 mmHg was a clear indication of increased risk, which would mean that far more people should be considered for treatment if there is such a difference between arms. present. To this end, the research team has created a tool that is easy for clinicians to use, to determine who should be evaluated for treatment based on their risk, taking into account -into blood pressure readings in both arms.
Co-author of the research Professor Victor Aboyans, head of the department of cartography at Dupuytren University Hospital in Limoges, France, said “We believe that a difference of 10 mmHg can now be considered a maximum. of normal for systolic intravenous blood pressure, when both arms are measured in order during routine clinical meetings.This information should be incorporated into future guidelines and clinical practice in cardiovascular risk assessment.It would mean that many more people would be considered for treatment that could reduce the risk of heart attack, stroke and death. “
An interstitial difference greater than 10 mmHg occurs in 11 per cent of people with high blood pressure (hip-tolerance) – itself a known health risk – and in four per cent of the population. space.
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The INTERPRESS-IPD collaboration includes the Universities of Oxford and Glasgow, the Université de Limoges in France and the Université du Québec à Trois-Rivières in Canada, working with colleagues in Spain, Taiwan, the USA, Denmark, Sweden, Germany, China, Holland. , Wales and Scotland.
The INTERPRESS-IPD Collaboration continues to explore other research questions regarding aspects of blood pressure measurement, and will publish further findings that should support better error in blood pressure measurement across next year.
The title of the paper is ‘Associations between Systolic Interarm Differences in Blood Pressure and Outcomes of Cardiovascular Disease and Mortality. Meta-analysis of individual participant data, development and validation of predictive algorithms: INTERPRESS-IPD collaboration ‘
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