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Blood pressure. Assessment of interarm differences
1Department of Emergency Medicine, University Medical Center, State University of New York, Stony Brook, USA.
Archives of Internal Medicine
|September 23, 1996
Summary
Normal blood pressure variation between arms is wider than previously assumed. Over half of patients showed a difference over 10 mm Hg, highlighting the need to redefine diagnostic thresholds for conditions like aortic dissection.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Accuracy
Background:
- A significant interarm blood pressure difference is often used to detect aortic dissection.
- However, the typical range of normal blood pressure variation between arms is not well-established.
Purpose of the Study:
- To quantify the normal variation in bilateral upper-extremity blood pressure measurements.
- To assess the prevalence of substantial interarm blood pressure differences in an emergency department population.
Main Methods:
- A prospective observational study was conducted on 610 ambulatory patients in a university hospital emergency department.
- Automated, bilateral upper-extremity blood pressure measurements were taken.
- Clinical, demographic, and diagnostic data were collected.
Main Results:
- 53% of patients exhibited a systolic or diastolic interarm blood pressure difference exceeding 10 mm Hg.
- 19% of patients had an interarm difference greater than 20 mm Hg.
- This variation was independent of age, sex, race, or cardiovascular risk factors, but higher in patients with known coronary artery disease.
Conclusions:
- Automated, indirect measurement of bilateral upper-extremity blood pressure reveals considerable interarm variation.
- These findings suggest current diagnostic criteria for conditions like aortic dissection may need re-evaluation based on this wide normal variation.