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Wander GS, McDonagh STJ, Rao MS, Alagesan R, Mohan JC, Bhagwat A, Pancholia AK, Viswanathan M, Chopda MB, Purnanand A, Kapardhi P, Vadavi AR, Selvaraj R, Aneja P, Hardas S, Bordoloi N, Sivakadaksham N, Goswami CE, Clark CE, Verberk WJ. Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian Primary Care. J Clin Hypertens (Greenwich) 2022. [PMID: 36468352 DOI: 10.1111/jch.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter-arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs. 134.2 mmHg (p<0.01) and diastolic BP 82.7 vs. 82.6 mmHg (p<0.01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7813 (5.8%). Systolic IAD ≥ 15 mmHg 2980 (2.2%) and diastolic IAD ≥ 10 mmHg 7151 (5.3%). In total, there were 7595 (5.6%) and 8548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exist in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasise the importance of undertaking bilateral BP measurement in routine clinical practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sinead T J McDonagh
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | | | - R Alagesan
- G. A. Vasant compu cardiac scan centre, Chennai, India
| | - J C Mohan
- Jaipur Golden Hospital Rohini, Delhi, India
| | | | | | | | | | | | | | | | - R Selvaraj
- Preetham Cardiac Care, Coimbatore, India
| | | | - Suhas Hardas
- Poona Hospital and Research Center, Pune & Clinic: Hardas Heart Care, Pune, India
| | | | | | | | - Christopher E Clark
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, the Netherlands
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Wander GS, McDonagh STJ, Rao MS, Alagesan R, Mohan JC, Bhagwat A, Pancholia AK, Viswanathan M, Chopda MB, Purnanand A, Kapardhi PLN, Vadavi AR, Selvaraj R, Aneja P, Hardas S, Bordoloi N, Sivakadaksham N, Goswami N, Clark CE, Verberk WJ. Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian primary care. J Clin Hypertens (Greenwich) 2022; 24:993-1002. [PMID: 35811439 PMCID: PMC9380175 DOI: 10.1111/jch.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter‐arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.
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Affiliation(s)
- Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sinead T J McDonagh
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | | | - R Alagesan
- G. A. Vasant Compu Cardiac Scan Centre, Chennai, India
| | - J C Mohan
- Jaipur Golden Hospital Rohini, Delhi, India
| | | | | | | | | | | | | | | | - R Selvaraj
- Preetham Cardiac Care, Coimbatore, India
| | | | - Suhas Hardas
- Poona Hospital and Research Center, Pune & Clinic: Hardas Heart Care, Pune, India
| | | | | | | | - Christopher E Clark
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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