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[The interarm blood pressure difference in the critically ill patient]
Josefa Valls Matarín1, Mercedes del Cotillo Fuente1, Salvador Quintana Riera2
1Enfermería, Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, España.
Medicina Clinica
|January 22, 2013
Summary
A significant difference in systolic blood pressure (SBPd) of 10 mmHg or more between arms affects over a quarter of critical care patients. This blood pressure difference is linked to prior hypertension and decreased consciousness.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Clinical Diagnostics
Background:
- A difference in systolic blood pressure (SBPd) of 10 mmHg or more between arms is a potential indicator of underlying cardiovascular issues.
- Its prevalence and associated factors in critically ill patients are not well-established.
Purpose of the Study:
- To determine the frequency of SBPd ≥ 10 mmHg in patients admitted to a Critical Care Unit.
- To identify clinical characteristics associated with this inter-arm blood pressure difference.
Main Methods:
- An observational, cross-sectional study was conducted.
- Two systolic blood pressure measurements were taken from each arm upon unit admission, with the initially measured arm selected randomly.
Main Results:
- The study included 168 patients (mean age 61, 67.3% male), with 45% having a history of hypertension.
- On admission, 27.4% of patients exhibited an SBPd ≥ 10 mmHg.
- An SBPd ≥ 10 mmHg was significantly associated with a previous diagnosis of hypertension (67.4% vs. 36.9%, P<.001) and reduced consciousness (76.1% vs. 52.5%, P=.006).
Conclusions:
- Over a quarter of critically ill patients present with an inter-arm SBPd ≥ 10 mmHg.
- This finding is correlated with a history of hypertension and diminished consciousness.
- Further research is warranted to explore if standardizing the measurement arm could enhance patient care and hemodynamic management accuracy.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
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