title: Prevalence and implications of a difference in systolic blood pressure between one arm and the other in vascular surgical patients.
abstract: Inter-arm differences in blood pressure may confound haemodynamic management in vascular surgery. We evaluated 898 patients in the vascular pre-assessment clinic to determine the prevalence of inter-arm differences in systolic and mean arterial pressure, quantify the consequent risk of clinical error in siting monitoring peri-operatively and evaluate systolic inter-arm difference as a predictor of all-cause mortality (median follow-up 49 months). The prevalence of a systolic inter-arm difference ≥ 15 mmHg was 26% (95% CI 23-29%). The prevalence of an inter-arm mean arterial pressure difference ≥ 10 mmHg was 26% (95% CI 23-29%) and 11% (95% CI 9-13%) for a difference ≥ 15 mmHg. Monitoring could be erroneously sited in an arm reading lower for systolic pressure once in every seven to nine patients. The hazard ratio for a systolic inter-arm difference ≥ 15 mmHg vs < 15 mmHg was 1.03 (95% CI 0.78-1.36, p = 0.84). Large inter-arm blood pressure differences are common in this population, with a high potential for monitoring errors. Systolic inter-arm difference was not associated with medium-term mortality. [Correction added on 17 October 2013, after first online publication: In the Summary the sentence beginning 'We evaluated 898 patients' was corrected from (median (IQR [range]) follow-up 49 months) to read (median follow up 49 months)].
authors.affiliation: Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Durrand
authors.forename: A M
authors.initials: AM
authors.lastname: Batterham
authors.forename: B R
authors.initials: BR
authors.lastname: O'Neill
authors.forename: G R
authors.initials: GR
authors.lastname: Danjoux
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply* / Q000503:physiopathology; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013599:Systole; D014656:Vascular Surgical Procedures