Varying blood pressure readings in each arm linked to lower survival rates

A study published on bmj.com reveals that individuals with hypertension whose blood pressure (BP) readings are different in each arm have lower survival rates over 10 years. According to national guidelines, physicians should measure blood pressure in both arms in many patients, however, these guidelines are often not followed as a result of insufficient evidence and time pressures. The researchers state that measuring BP in both arms should be routinely part of measuring BP and subsequent treatment. The teams findings back results of an earlier study they conducted which indicated that different readings in each arm are linked to increased mortality risk over 5 years, and are a predictor of reduced survival. In this study, the researchers at Peninsula College of Medicine and Dentistry examined 230 patients between 1999 and 2002 in order to determine the difference in survival rates after 10 years. All 230 individuals had hypertension and were patients at a GP practice in rural Devon. Frequently, blood pressure is measured in both arms in individuals who are at increased cardiovascular risk due to diabetes, chronic renal disease, or peripheral vascular disease, and in healthy antenatal women. According to research, delayed diagnoses and poor control of hypertension could partially be caused by different blood pressure readings in both arms. After the researchers adjusted for age and gender, they found that for every 1 mmHg inter-arm differences in blood pressure, the risk of death increased by 9%. These results indicate that BP should be routinely measured in all individuals receiving treatment for high blood pressure. Results from the study contribute to evidence supporting the need to detect a difference. The researchers hope that this new evidence will help to improve the measurement and management of hypertension. Although a more intensive evaluation requires training, experience and time, the authors believe that patients could benefit. They conclude that results from the study support the view of "inter-arm difference as a simple indicator of increased cardiovascular risk." According to the researchers, when treating patients with hypertension in primary care, evaluation of blood pressure in both arms should become a "core component." In an associated report, Dr. Dae Hyun Kim from Harvard Medical School states that for individuals with an inter-arm difference, blood pressure monitoring should continue to be performed in the arm with the higher reading. Dr. Kim notes that this will help physicians determine necessary treatment, although further research is required in order to establish the association between inter-arm blood pressure reading and mortality.