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(Hypertension. 2008;52:e14.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Prognostic Significance of Between-Arm Blood Pressure Differences: Between-Arm Blood Pressure Difference and Mortality

Diabetes Centre, Isala Clinics, Zwolle, The Netherlands, Langerhans Medical Research Group, Zwolle, The Netherlands

Susan J.J. Logtenberg; Henk J.G. Bilo

Diabetes Centre, Isala Clinics, Zwolle, The Netherlands

To the Editor:

With interest we read the recent article in Hypertension by Agarwal et al.¹ The authors conclude that blood pressure differences between arms are reproducible and that this difference is related to mortality.

We have some concerns with the methods and conclusions of this study.¹ First, is the blood pressure device that was used validated? Second, the conclusion about the reproducibility concerns a remeasurement after only 1 week. In a study that we performed regarding possible between-arm blood pressure differences in patients with type 2 diabetes, we found that an interarm blood pressure difference of 10 mm Hg was not reproducible in 79% of patients after 1 year.² Third, we wonder whether it is the interarm blood pressure that is related to mortality or whether it is the variability of blood pressure readings induced by irregular heart rhythm. If so, these patients could have greater interarm blood pressure differences and a higher mortality risk attributable to heart rhythm disturbances.

Furthermore, in our study we found that, at baseline, 33% of patients had an interarm blood pressure difference of >10 mm Hg. However, 25% of patients also had an intra-arm blood pressure difference of >10 mm Hg (device used: Omron M5-1). The same phenomenon of blood pressure fall while sequentially measuring at 1 arm seems to occur when measuring sequentially first at 1 arm and then at the other. In our article we reviewed 10 studies about this subject and concluded that it depends a great deal on whether blood pressure is measured simultaneously on both arms or not and how many consecutive measurements are performed. Studies using simultaneous measurements found less interarm blood pressure differences; the more consecutive measurements performed, the less interarm blood pressure differences were found. One study comparing the means of 8 measurements found no interarm blood pressure difference at all.³ Therefore, it can be questioned whether, apart from patients with, eg, 1-sided artery stenosis, interarm blood pressure differences really exist.

We ask the authors to elucidate some of the questions raised. Furthermore, we ask them whether it would be possible to further analyze their data to investigate whether an intra-arm variability is also related to mortality. Finding such a relationship would imply that it is not interarm difference but blood pressure variability that is related to mortality.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Agarwal R, Bunaye Z, Bekele DM. Prognostic significance of between-arm blood pressure differences. Hypertension. 2008; 51: 657–662.[Abstract/Free Full Text]

2. Kleefstra N, Houweling ST, Meyboom-de Jong B, Bilo HJ. Measuring the blood pressure in both arms is of little use; longitudinal study into blood pressure differences between both arms and its reproducibility in patients with diabetes mellitus type 2. Ned Tijdschr Geneeskd. 2007; 151: 1509–1514.[Medline] [Order article via Infotrieve]

3. Gould BA, Hornung RS, Kieso HA, Altman DG, Raftery EB. Is the blood pressure the same in both arms? Clin Cardiol. 1985; 8: 423–426.[Medline] [Order article via Infotrieve]

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				R. Agarwal Response to Prognostic Significance of Between-Arm Blood Pressure Differences: Between-Arm Blood Pressure Difference and Mortality and the Interarm Blood Pressure Difference: Between-Arm Blood Pressure Differences Are Important Hypertension, August 1, 2008; 52(2): e16 - e17. [Full Text] [PDF]

This Article Extract Full Text (PDF) All Versions of this Article: 52/2/e14    most recent HYPERTENSIONAHA.108.115790v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kleefstra, N. Articles by Bilo, H. J.G. Search for Related Content PubMed PubMed Citation Articles by Kleefstra, N. Articles by Bilo, H. J.G. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Other hypertension