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Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

Abstract

A blood pressure (BP) difference between arms was first reported over 100 years ago. Knowledge of its prevalence and relevance to the accurate measurement of BP remains poor. Current hypertension guidelines do not emphasise it. The objectives of this study were to establish the best estimate of prevalence of the inter-arm difference (IAD) in the population, to consider its implications for accurate BP measurement and treatment, and to discuss its aetiology and potential as a risk marker for cardiovascular disease. Systematic literature review was carried out. The data sources were Medline EMBASE and CINAHL databases, and Index of Theses. Studies reporting prevalence rates of IAD were retrieved and considered for inclusion against explicit methodological criteria. Point prevalence rates were extracted and weighted mean prevalence rates calculated. The main outcome measures were weighted mean prevalences of systolic IAD10 and 20 mm Hg and of diastolic IAD10 mm Hg. Thirty-one studies were identified. Most had methodological weaknesses; only four met the inclusion criteria. Pooled prevalences of the IAD from these four studies were 19.6% systolic 10 mm Hg (95% CI 18.0–21.3%), 4.2% systolic 20 mm Hg (95% CI 3.4–5.1%) and 8.1% diastolic 10 mm Hg (95%CI 6.9–9.2%). In conclusion, an IAD is present in a substantial number of patients and should be looked for whenever diagnosis and treatment depend on accurate measurements of BP. The importance of an IAD should be better emphasised in current hypertension management guidelines. There is evidence associating an IAD with peripheral vascular disease, raising the possibility that its presence may predict cardiovascular events.

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Acknowledgements

CEC was supported by a Clinical Academic Fellowship from Plymouth tPCT and a grant from Mid Devon Research Group. We owe thanks to Ginny Newton and her colleagues at Exeter Medical Library for their persistence in obtaining so many historic papers and books for this review.

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Appendix A

Appendix A

Table A1

Table a1 Summary of excluded studies

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Clark, C., Campbell, J., Evans, P. et al. Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review. J Hum Hypertens 20, 923–931 (2006). https://doi.org/10.1038/sj.jhh.1002093

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