Published Online
on January 22, 2008

A more recent version of this article appeared on March 1, 2008

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Submitted on November 12, 2007
Revised on December 4, 2007

Prognostic Significance of Between-Arm Blood Pressure Differences

Rajiv Agarwal^*; Zerihun Bunaye; and Dagim M. Bekele

From the Indiana University School of Medicine and Richard L. Roudebush Veterans’ Administration Medical Center, Indianapolis.

^* To whom correspondence should be addressed. E-mail: ragarwal{at}iupui.edu.

Abstract—Blood pressure (BP) recordings often differ between arms, but the extent to which these differences are reproducible and whether the differences have prognostic importance is unknown. We enrolled 421 consecutive patients from a medicine and a renal clinic at a veterans’ hospital. Three BP recordings were obtained in each arm using an oscillometric device in a sequential manner and repeated in 1 week. Patients were followed for all-cause mortality 7 years. The right arm had 5.1-mm Hg higher systolic BP that attenuated by 2.2 mm Hg a week later. Systolic BP dropped 6.9 mm Hg over 1 week and by an additional 5.3 mm Hg in patients with chronic kidney disease. Accounting for the visit and arm effect improved the reproducibility of the BP measurements. The intraclass correlation coefficient was 0.74, which improved to 0.88 after accounting for visit and 0.93 after accounting for arm. The crude mortality rate was 6.33 per 100 patient-years. Every 10-mm Hg difference in systolic BP between the arms conferred a mortality hazard of 1.24 (95% CI: 1.01 to 1.52) after adjusting for average systolic BP and chronic kidney disease. BP differences between arms are reproducible and carry prognostic information. Patients should have evaluation of BP in both arms at the screening visit.

Key words: hypertension • blood pressure measurement • mortality • cohort study • survival analysis

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