title: The difference in blood pressure readings between arms and survival: primary care cohort study.
abstract: OBJECTIVE
  To determine whether a difference in systolic blood pressure readings between arms can predict a reduced event free survival after 10 years.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Rural general practice in Devon, United Kingdom.
  
  
  METHODS
  230 people receiving treatment for hypertension in primary care.
  
  
  METHODS
  Bilateral blood pressure measurements recorded at three successive surgery attendances.
  
  
  METHODS
  Cardiovascular events and deaths from all causes during a median follow-up of 9.8 years.
  
  
  RESULTS
  At recruitment 24% (55/230) of participants had a mean interarm difference in systolic blood pressure of 10 mm Hg or more and 9% (21/230) of 15 mm Hg or more; these differences were associated with an increased risk of all cause mortality (adjusted hazard ratio 3.6, 95% confidence interval 2.0 to 6.5 and 3.1, 1.6 to 6.0, respectively). The risk of death was also increased in 183 participants without pre-existing cardiovascular disease with an interarm difference in systolic blood pressure of 10 mm Hg or more or 15 mm Hg or more (2.6, 1.4 to 4.8 and 2.7, 1.3 to 5.4). An interarm difference in diastolic blood pressure of 10 mm Hg or more was weakly associated with an increased risk of cardiovascular events or death.
  
  
  CONCLUSIONS
  Differences in systolic blood pressure between arms can predict an increased risk of cardiovascular events and all cause mortality over 10 years in people with hypertension. This difference could be a valuable indicator of increased cardiovascular risk. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.
authors.affiliation: Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, University of Exeter, Devon EX1 2LU, UK. christopher.clark@pms.ac.uk
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Clark
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.forename: Angela C
authors.initials: AC
authors.lastname: Shore
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001132:Arm; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D018572:Disease-Free Survival; D004739:England; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012107:Research Design; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents