Peripheral vascular disease is a risk factor for future heart and circulatory diseases. It is associated with narrowing and hardening of the arteries which leads to a drop in blood flow in the legs. If the condition is detected at an early stage, treatment such as stopping smoking, lowering blood pressure, or offering statin therapy can reduce death rates.
Dr Christopher Clark from the Peninsula College of Medicine and Dentistry, University of Exeter, and colleagues examined 20 studies covering differences in systolic blood pressure between arms. Systolic blood pressure is one of two numbers recorded during a blood pressure check and measures the pressure of blood in arteries when the heart is contracting.
In a paper published in the online edition of The Lancet, the researchers say they found evidence to suggest that a difference of 15mm Hg or more in the readings between the left and right arms increased the risk of peripheral vascular disease by two-and-a-half times.
They also found that the same difference in systolic readings increased the risk of cerebrovascular disease by 60%. Cerebrovascular disease is associated with thinking problems, such as vascular dementia, and an increased risk of stroke.
Risk of dying
The risk of dying from heart and circulatory diseases rose by 70%, the authors found.
The risk of peripheral vascular disease was also higher when there was a difference in blood pressure readings of 10mm Hg or more.
The researchers said their study supported a case for medical staff to take blood pressure readings from both arms to aid in early disease detection and death prevention. "Findings from our study should be incorporated into future guidelines for hypertension and blood-pressure measurement to justify bilateral brachial measurement in the assessment of individuals, and to promote targeted screening for peripheral vascular disease and aggressive risk factor management in subjects with a demonstrable systolic between-arm difference," they conclude.
They said they would be flagging their findings to the UK Vascular Check Programme.
Commenting on the research, Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said in an emailed statement: "Theoretically, measuring blood pressure on both arms to assess vascular disease risk is a quick and simple task. But it’s too early to say whether this idea could become part of standard healthcare practice and so we need more research to confirm the findings.
"It’s very important that other risk factors, apart from high blood pressure, are taken into account to establish whether doctors need to take a closer look at someone’s heart disease risk."
In a linked Comment article in the same edition of The Lancet, Professor Richard McManus of the University of Oxford and Professor Jonathan Mant of the University of Cambridge write that more research is needed to clarify whether differences in blood pressure reading justify the preventive measures suggested.
They added: "Overall, Clark and colleagues’ systematic review and meta-analysis supports existing guidelines stating that blood pressure should be measured in both arms. Ascertainment of differences should become part of routine care, as opposed to a guideline recommendation that is mostly ignored."
'Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis', Christopher Clark, Published Online
January 30, 2012.
British Heart Foundation.
'Do differences in blood pressure between arms matter?', Professor Richard McManus, Professor Jonathan Mant, Published Online January 30, 2012.
Press release, The Lancet.
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