It has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of < 5 mm Hg in simultaneous BP measurements. The purposes of this study is to examine whether there are between-arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences.
We examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|).
The mean absolute IAD in SBP and DBP were 3.19 ± 2.38 and 2.41 ± 1.59 mm Hg, respectively, in men and 2.61 ± 2.18 and 2.25 ± 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of ≤ 6 mm Hg, 98.1% with the IAD in SBP of ≤ 10 mm Hg, 96.5% with the IAD in DBP of ≤ 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of ≤ 6 mm Hg, 92.1% with IAD in DBP of ≤ 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function.
Our results showed that there were no significant between-arm differences in simultaneous BP measurements. It was also shown that most of the ambulatory patients without cardiovascular diseases had an IAD in SBP of < 10 mm Hg and an IAD in DBP of < 6 mm Hg.
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According to the current guidelines for blood pressure monitoring, clinicians are recommended to measure blood pressure by completely exposing the upper arm. However, it is a common practice that blood pressure is measured with the cuff placed over the sleeve or with the sleeve rolled up. We therefore conducted this study to examine whether there are any differences in blood pressure measurements among the three different settings: the sleeve group, the rolled sleeve group, and the bare arm group.
We conducted the current study in 141 male and female adult patients who visited our clinical department. In these patients, we took repeatedly blood pressure measurements using the same automatic oscillometric device on three different settings. Then, we analyzed the results with the use of randomized block design analysis of variance.
The mean values of systolic blood pressure (SBP) between the first reading and those of the second reading were 128.5 ± 10.6 mm Hg in the sleeve group, 128.3 ± 10.8 mm Hg in the rolled sleeve group, and 128.3 ± 10.7 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.32). In addition, the mean values of diastolic blood pressure (DBP) between the first reading and those of the second reading were 80.7 ± 6.1 mm Hg in the sleeve group, 80.7 ± 6.1 mm Hg in the rolled sleeve group, and 80.6 ± 5.9 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.77). In addition, based on the age, sex, past or current history of hypertension or diabetes mellitus, the thickness of sleeve, weight, a drinking history, and a smoking history, there were no significant differences in SBP and DBP among the three groups.
There were no significant differences in blood pressure measurements between the three different settings (the sleeve group, the rolled sleeve group, and the bare arm group).
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