Prevalence and implications of a difference in systolic blood pressure between one arm and the other in vascular surgical patients

• Published in: Anaesthesia Vol. 68; no. 12; pp. 1247 - 1252
• Main Authors: Durrand, J. W., Batterham, A. M., O'Neill, B. R., Danjoux, G. R.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-12-2013
• Subjects: Aged; Arm - blood supply; Arm - physiopathology; Arms; Blood Pressure; Blood Pressure Determination - methods; Blood Pressure Determination - statistics & numerical data; Differences; Female; Follow-Up Studies; Humans; Male; Prevalence; Proportional Hazards Models; Retrospective Studies; Survival Analysis; Systole; Vascular surgery; Vascular Surgical Procedures
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.12452

Summary
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)]