Research

full-text►

The difference in blood pressure readings between arms and survival: primary care cohort study | BMJ

The difference in blood pressure readings between arms and survival: primary care cohort study

BMJ2012;344doi: 10.1136/bmj.e1327(Published 20 March 2012)

Cite this as:BMJ2012;344:e1327

• Cardiovascular medicine
• Drugs: cardiovascular system
• Epidemiologic studies
• Epidemiology

More topics
• General practice / family medicine
• Hypertension
Fewer topics

• Article
• Related content
• Article metrics

1. Christopher E Clark, clinical academic fellow1,
2. Rod S Taylor, professor in health services research, medical statistician1,
3. Angela C Shore, professor of cardiovascular science2,
4. John L Campbell, professor of general practice and primary care1

Author Affiliations

1. ¹Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, University of Exeter, Devon EX1 2LU, UK
2. ²Institute of Biomedical and Clinical Science, Peninsula College of Medicine and Dentistry, and Peninsula NIHR Clinical Research Facility, University of Exeter, Devon, UK

1. Correspondence to: C E Clark christopher.clark@pms.ac.uk

• Accepted 13 January 2012

Abstract

Objective To determine whether a difference in systolic blood pressure readings between arms can predict a reduced event free survival after 10 years.

Design Cohort study.

Setting Rural general practice in Devon, United Kingdom.

Participants 230 people receiving treatment for hypertension in primary care.

Intervention Bilateral blood pressure measurements recorded at three successive surgery attendances.

Main outcome measures Cardiovascular events and deaths from all causes during a median follow-up of 9.8 years.

Results At recruitment 24% (55/230) of participants had a mean interarm difference in systolic blood pressure of 10 mm Hg or more and 9% (21/230) of 15 mm Hg or more; these differences were associated with an increased risk of all cause mortality (adjusted hazard ratio 3.6, 95% confidence interval 2.0 to 6.5 and 3.1, 1.6 to 6.0, respectively). The risk of death was also increased in 183 participants without pre-existing cardiovascular disease with an interarm difference in systolic blood pressure of 10 mm Hg or more or 15 mm Hg or more (2.6, 1.4 to 4.8 and 2.7, 1.3 to 5.4). An interarm difference in diastolic blood pressure of 10 mm Hg or more was weakly associated with an increased risk of cardiovascular events or death.

Conclusions Differences in systolic blood pressure between arms can predict an increased risk of cardiovascular events and all cause mortality over 10 years in people with hypertension. This difference could be a valuable indicator of increased cardiovascular risk. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.