Prevalence and related factors of abnormal four-limb blood pressure difference in elderly people in Shanghai / 上海交通大学学报（医学版）

Objective • To investigate the prevalence and related factors of abnormal four-limb blood pressure difference in elderly people in Shanghai. Methods • From 2016 to 2018, the elderly aged 60 years and over in Zhaoxiang Town, Qingpu District, Shanghai were selected by cluster sampling. General data was collected. Height, body mass, and blood pressure were measured. Fasting venous blood was taken for routine blood test, blood glucose, blood lipids, serum creatinine and other biochemical indicators. Four limb blood pressures were measured simultaneously by Vascular Profiler-1000 device, from which ankle-brachial index, inter-arm systolic pressure difference and inter-ankle systolic pressure difference were calculated. Multivariate Logistic regression was used to analyze the related factors of abnormal four-limb blood pressure difference. Results • A total of 4 090 subjects were enrolled with an average age of (68.5±7.6) years, of which 44.6% were males. The people with hypertension and diabetes mellitus accounted for 60.1% and 8.6%, respectively. The prevalence of ankle-brachial index≤ 0.90, inter-arm systolic pressure difference≥ 15 mmHg (1 mmHg=0.133 kPa) and inter-ankle systolic pressure difference≥ 15 mmHg were 2.7%, 1.9%, and 8.4%, respectively. After incorporating age, sex, body mass index (BMI), smoking, drinking, hypertension, diabetes mellitus, total cholesterol and triacylglycerol, the results of multiple Logistic regression analysis showed that age and hypertension were the related factors of the three indicators for abnormal four-limb blood pressure difference. The related factors of ankle-brachial index ≤ 0.90 also included diabetes mellitus, total cholesterol and smoking; the related factors of inter-arm systolic pressure difference≥ 15 mmHg also included BMI; the related factors of inter-ankle systolic pressure difference≥ 15 mmHg also included BMI and diabetes mellitus. Conclusion • Abnormal four-limb blood pressure difference is prevalent among the elderly in Shanghai, of which old age, hypertension, diabetes, dyslipidemia, obesity and smoking are risk factors.

Blood pressure measurement: One arm or both arm.

Guidelines for measuring blood pressure includes measurement of blood pressure on both arms but it is often ignored. Our case report aims at highlighting the need follow the guidelines. A 60 year old 59 kg weighing male asymptomatic patient without any comobidities was posted for bilateral inguinal hernia repair. The interarm blood pressure difference was discovered incidentally during his preanaesthetic evalution. On further evaluation patient was found to be having subclavian stenosis on left side which was asymptomatic. Intraoperative and post operative period was uneventful. Blood pressure measurement should be done in accordance with the stipulated guidelines. Inter arm blood pressure difference should be noted in all patients as not only for diagnosis and treatment of hypertension but also as a tool to diagnose asymptomatic peripheral vascular disesase.

A Case of Successful Correction of Subclavian Steal Syndrome by Percutaneus Transluminal Angioplasty with Stenting Who Found Incidentally Significant Interarm Blood Pressure Difference / 가정의학회지

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.

Assessment of Disparity in the Blood Pressure of Both Arms

PURPOSE: Inter-arm blood pressure differences of more than 10 mmHg are measured not only in patients who have vascular diseases, such as aortic dissections, and aortic aneurysms, but also in heathy patients. We investigated the degree of and the factors for normal inter-arm blood pressure variations in our country. METHODS: We prospectively studied the cases of 351 patients who visited the Emergency Department of Korea University Hospital between May 1 and July 31, 2001. we collected clinical and demographic data, including age, sex, right/left handedness, and bilateral blood pressure. After we divided the cases into a Normal blood pressure group and a High blood pressure group, we compared the inter-arm blood pressure difference and influencing factors between the two group. RESULTS: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm in both groups. In the Normal blood pressure group (n=180), the systolic inter-arm blood pressure difference was 3.9+/-0.4 mmHg, and the diastolic inter-arm blood pressure difference was 3.6+/-0.4 mmHg. In the High blood pressure group (n=171), the systolic inter-arm blood pressure difference was 5.2+/-0.5 mmHg, and the diastolic interarm blood pressure difference was 4.8+/-0.5 mmHg. CONCLUSION: The variation in the inter-arm blood pressure was unrelated to age, sex, right/left handedness, and right/left arm. But inter-arm blood pressure difference was significant among subjects without exclusion criteria and was measured as about 5 mmHg in two groups.

Blood Pressure Difference between Right and Left Arms of Some College Freshmen

BACKGROUND: Hypertension is a main cause of heart blood vessel disease. To diagnose and treat hypertension, it is necessary to measure blood pressure accurately. There are various factors that influence blood pressure. According to real clinical demonstrators and some recent studies, blood pressure differences between right and left arms are often observed. This study was intended to know whether the differences are really found and wheather the correlation exists between mid-arm circumferences and the blood pressure differences according to right-handed or left-handed which were considered as an important factor in affecting blood pressures. METHODS: One hundred sixty nine college freshmen of year 2001 were chosen. Among them, 103 were right- handed and 66 left-handed. Which arms to be checked first were determined randomly. This sequence was repeated two times on each person. Their mid-arm circumferences were measured, also. RESULTS: For right-handed persons, systolic blood pressure in right arm (119.2+/-12.3 mmHg) was significantly higher than in left arm (118.0+/-12.0 mmHg) (P<0.005). But diastolic blood pressure differences between right arm (75.3+/-10.0 mmHg) and left arm (75.0+/-9.5 mmHg) was not significant statistically. For left-handed persons, systolic blood pressure was 120.3+/-9.9 mmHg in right arm and 120.0+/-10.3 mmHg in left arm. However, diastolic blood pressure in right arm (76.7 9.4 mmHg) was significantly higher than in left arm (75.0+/-8.6 mmHg) (P<0.005). For right handed persons, their arm circumferences (26.2+/-2.8 cm) were significantly thicker than left ones (25.9+/-2.9 cm). For left-handed, left arm circumference (25.9+/-2.7 cm) was significantly thicker than right one (25.5+/-2.6 cm). As for the blood pressure difference in arm tested order, the first measured systolic blood pressure (right arm; 120.9+/-11.7 mmHg, left arm; 120.0+/-11.9 mmHg) was significantly higher than the second measured one (right arm; 118.3+/-11.8 mmHg, left arm; 117.8+/-11.6 mmHg) (P<0.005). However, the first measured diastolic blood pressure (right arm; 76.3+/-10.5 mmHg, left arm; 75.5+/-9.4 mmHg) did not have more significance than the second measured one (right arm; 75.4+/-9.9 mmHg, left arm; 74.6+/-10.8 mmHg). CONCLUSION: The right-handed person's blood pressure was higher in the right arm, but for the left-handed persons it was not significantly different in both arms. The second measurement of blood pressure was lower than the first measurement in both arms. The arm circumference depending on the right/left-handedness influenced the blood pressure, but clear correlation between them was not observed. Therefore, if possible, when the blood pressure is measured, it is advised to check blood pressure in both arms before diagnosing hypertension.