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… continued from page 203
‘We’ve long known that a difference in blood pressure
between the two arms is linked to poorer health outcomes. The
large numbers involved in the INTERPRESS-IPD study help
us to understand this in more detail. It tells us that the higher
the difference in blood pressure between arms, the greater the
cardiovascular risk, so it really is critical to measure both arms
to establish which patients may be at significantly increased
risk. Patients who require a blood pressure check should now
expect that it’s checked in both arms, at least once.’
Blood pressure rises and falls in a cycle with each pulse.
It is measured in units of millimetres of mercury (mmHg),
and the reading is always given as two numbers: the upper
(systolic) reading represents the maximum blood pressure
and the lower (diastolic) value is the minimum blood pressure.
A high systolic blood pressure indicates hypertension. This
affects one third of the adult population and is the single
leading cause globally of preventable heart attacks, strokes
and deaths. A significant difference between the systolic blood
pressure measurements in the two arms could be indicative of
a narrowing, or a stiffening, of the arteries, which can affect
blood flow. These arterial changes are recognised as a further
risk marker for subsequent heart attack, stroke or early death,
and should be investigated for treatment.
The researchers concluded that each mmHg difference
found between the two arms elevated predicted 10-year
risk of one of the following occurring by one percent: new
angina, a heart attack or stroke.
At the moment, both UK and European guidelines recognise
a systolic difference of 15 mmHg or more between the two
arms as the threshold indicative of additional cardiovascular
risk. This study found that a lower threshold of 10 mmHg was
clearly indicative of additional risk, which would mean that
far more people should be considered for treatment if such a
difference between arms is present. To this end, the research
team has created a tool that is easy for clinicians to use, to
establish who should be considered for treatment based on their
risk, incorporating the blood pressure reading in both arms.
Research co-author Professor Victor Aboyans, head of
the department of cardiology at the Dupuytren University
Hospital in Limoges, France, said ‘We believe that a 10-mmHg
difference can now reasonably be regarded as an upper limit
of normal for systolic inter-arm blood pressure, when both
arms are measured in sequence during routine clinical
appointments. This information should be incorporated
into future guidelines and clinical practice in assessing
cardiovascular risk. It would mean many more people were
considered for treatment that could reduce their risk of heart
attack, stroke and death.’
Source:
Medical Brief 2020