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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 4, July/August 2021
AFRICA
203
generalisations cannot be drawn to all of Khartoum state, only
to populations with characteristics similar to those of the sample.
Since no standardised tool for assessing knowledge and
practice of patients towards lifestyle changes exists, the
researcher designed the questionnaire based on the literature
and what would be applicable to the study population. Hence
the comparison of results between different studies is difficult.
Another limitation was that implementation of lifestyle changes
was assessed by yes/no questions and no varying degrees of
implementation were reported, which may have made the results
less accurate.
Conclusion
This study demonstrated that hypertensive patients were
generally knowledgeable about hypertension and the importance
of TLC in its management, particularly the importance of
minimising salt intake. Patients implemented regular exercise
least often and gave ‘don’t think it matters’ or ‘laziness’ as their
main perceived barrier. Participants gave this reason despite
ample knowledge of lifestyle changes and being advised by
doctors on these changes. This was deduced since no association
was found between patients’ level of knowledge or duration of
consultation and their degree of implementation of lifestyle
change. The researcher believes that novel approaches are
needed to help motivate patients diagnosed with hypertension
apply their knowledge regarding TLC.
The author recommends more comprehensive research on
this topic to accurately ascertain patients’ perception of TLC as
adjuncts to pharmacological therapy. Once patients’ perceived
barriers are better understood, novel and more effective
approaches to consultation may then be developed and applied.
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Inter-arm difference in blood pressure robustly linked to greater early death risk
Robust evidence from a large meta-analysis published in
Hypertension
confirms that a difference in blood pressure
readings between arms is linked to greater risk of heart
attack, stroke and death. The study provides a new upper
limit of ‘normal’ for an inter-arm difference in blood pressure,
which is significantly lower than the current guidance.
Led by the University of Exeter, the global INTERPRESS-
IPD collaboration conducted a meta-analysis of all the
available research, then merged data from 24 global studies to
create a database of nearly 54 000 people. The data spanned
adults from Europe, the USA, Africa and Asia for whom
blood pressure readings for both arms were available.
Funded by the National Institute for Health Research
(NIHR), the study is the first to conclude that the greater the
inter-arm blood pressure difference, the greater the patient’s
additional health risk.
Currently, international blood pressure guidelines advise
health professionals to measure blood pressure in both arms
when assessing cardiovascular risk, yet this is widely ignored.
This study provides a new upper limit of ‘normal’ for an
inter-arm difference in blood pressure, which is significantly
lower than the current guidance. The research could lead
to a change in international hypertension guidelines,
meaning more at-risk patients could be identified and receive
potentially life-saving treatment.
In a methodology that put patients at its heart, working
with a patient advisory group at every step of the research, the
team analysed data on inter-arm blood pressure difference,
and tracked the number of deaths, heart attacks and strokes
that occurred in the cohort over 10 years.
Lead author and GP Dr Chris Clark, of the University
of Exeter Medical School, said: ‘Checking one arm then
the other with a routinely used blood pressure monitor
is cheap and can be carried out in any healthcare setting,
without the need for additional or expensive equipment. While
international guidelines currently recommend that this is done,
it only happens around half of the time at best, usually due to
time constraints. Our research shows that the little extra time it
takes to measure both arms could ultimately save lives.’
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