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Willem J. Verberk, Alfons G.H. Kessels, Theo Thien, Blood Pressure Measurement Method and Inter-Arm Differences: A Meta-Analysis, American Journal of Hypertension, Volume 24, Issue 11, November 2011, Pages 1201–1208, https://doi.org/10.1038/ajh.2011.125
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Screening for inter-arm difference (IAD) of blood pressure (BP) at each first visit is recommended by numerous guidelines whereas it is unclear whether the method by which IAD is measured has significant influence on the IAD value.
A systematic review is made of the studies reporting on double-arm measurements and the association of IAD with procedure characteristics (Medline/PubMed, Embase, and Cochrane Library).
The mean absolute IAD was 5.4 ± 1.7 and 3.6 ± 1.2mmHg for systolic and diastolic BP, respectively. Of all subjects 14% had a systolic IAD ≥10mmHg, 4% a systolic IAD ≥20mmHg, and 7% a diastolic IAD ≥10mmHg. The relative risk (RR) of obtaining a systolic IAD ≥10 and 20mmHg and a diastolic IAD ≥10mmHg is higher when measuring sequentially instead of simultaneously (2.2 (95% CI: 1.4–3.6), P < 0.01; 4.8 (95% CI: 1.1–21.9), P < 0.05 and 2.5 (95% CI: 1.0–6.3) P < 0.05, respectively), when using a manual instead of an automated device (2.1 (95% CI: 1.1–3.9), P < 0.05; 4.4 (95% CI: 1.8–10.8), P < 0.01 and 3.7 (95% CI: 1.6–8.6), P < 0.01, respectively) and when performing only one BP measurement instead of multiple (2.0 (95% CI: 1.1–3.8), P < 0.05; 4.3 (95% CI: 1.6–11.4), P < 0.01 and 4.4 (95% CI: 1.7–11.4), P < 0.01, respectively).
Screening for IAD of BP is important but the measurement methodology has a major influence on IAD results. To prevent overestimation and observer bias IAD should be assessed simultaneously at both arms, with one or two automatic devices and multiple readings should be taken.
American Journal of Hypertension (2011). doi:10.1038/ajh.2011.125
