Blood Pressure Measurement

The day may be rapidly approaching when your primary healthcare provider will take your blood pressure from both arms simultaneously.  That's according to a meta-analysis in this week's Lancet, also featured in our YouTube, taking a look at a number of studies that examined the difference in blood pressure between arms and its predictive value.  Turns out this low tech assessment method may provide an idea of whether blood vessels are either occluded or narrowed, putting someone at risk for a host of cardiovascular events.  As Rick points out in this week's podcast, a significant difference in these measurements suggests additional follow-up is needed.

A total of 20 studies were included for analysis in this paper.  Studies that included measurement of blood pressure in both arms and also stenosis or narrowing of the subclavian artery, (the major blood vessel to the arm), peripheral vascular disease, cerebrovascular disease, cardiovascular disease, or mortality were included. The analysis concluded that a difference of 15 mm Hg or more between arms was associated with the presence of vascular disease and all-cause mortality.  Even a 10mm Hg difference seemed to indicate the presence of peripheral vascular disease.

The authors and Rick agree that simultaneous measurement in both arms is the best method for obtaining these blood pressures, and that the devices must be calibrated properly.  Additionally, the patient must be seated for a minimum of five minutes previous to any attempt to obtain a blood pressure measurement, and of course, taking more than one measurement is advantageous.  Rick opines that this is rarely possible in a typical clinic setting and may hinder adoption of the practice, but since it isn't technically difficult to train health care providers other than physicians to obtain blood pressure measurements, it doesn't seem that onerous to me.

What I like about this study is it demonstrates a very low tech, low risk technique for identifying folks who may be at increased risk for vascular disease, cardiovascular events, and death.  Since it is a low tech method it can be done almost anywhere worldwide where two, ideally the same type, blood pressure measuring devices are available.  So in a country with the resources, a difference of 15mm Hg or more should prompt further evaluation and identification of the specific risk, as well as immediate strategies to reduce that risk, whether via blood pressure reduction, improvement of the cholesterol profile, perhaps through the use of statin medications, and implementation of lifestyle modifications, including exercise and smoking cessation.  Even in countries without the resources to follow up suspicion with more rigorous assessment, adoption of risk reduction strategies is likely to be of benefit.

Other studies this week include a look at re-excision among women who've already had surgery in early stage breast cancer, in JAMA, good news regarding survival for children who've been badly burned in the Lancet, and a stage 3 study of a potential new medication for uterine fibroids for NEJM.  Until next week, y'all live well.

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Aastha Jarma May 17, 2012 at 10:46 pm

FYI, here is an interesting set of case studies on blood pressure assessment, with patient simulations: Taking Blood Pressure .

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Jesse Greenblatt MD February 7, 2012 at 12:43 pm

I would highlight the recent article by Fowkes et al. in JAMA Mar 2010 that shows that even though we can identify persons at higher risk of adverse cardiovascular events using a simple screening technique such as ABI's, the use of aspirin did not lower mortality in this group. I suspect the same would be true of those with discrepent arm systolic blood pressure readings.

Jesse Greenblatt MD, MPH
Cooperstown, NY

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Alf March 2, 2012 at 12:31 pm

Our body has a definite blood spserure. A drop in the said spserure is a condition termed as hypotension, more popularly low blood spserure. In such a condition, the heart forces the blood out of the arteries with much less strength than it should. Low blood spserure is an outcome of weakened and devitalized system. Some of the main causes of low blood spserure are faulty nutrition or malnutrition, emotional instability, loss of blood and slow internal bleeding. Lethargy, weakness, fatigue and dizziness are the most common symptoms of low blood spserure. A person might even faint, if the arterial spserure gets extremely low. Low blood spserure can, however, be treated naturally, using some home remedies. Read on to know how to cure low blood spserure, at home.Home Remedy For Low Blood Pressure * The best and the most effective home remedy for treating low blood spserure would be to consume lots of water. This is because dehydration reduces blood volume and leads to a drop in the blood spserure. * Beetroot juice is beneficial for those suffering from low blood spserure. So, have a cup of raw beetroot juice two times a day. * Prepare a cup of strong black coffee and consume this whenever you feel that your blood spserure is dipping. * Put 15-20 gm of Indian Spikenard in 250 ml water and boil it. Now, remove from heat and let it cool down. Have this infusion thrice a day. You can also have 30-40 grains of Indian Spikenard, along with some camphor and cinnamon. * Fill your bathtub with lukewarm water and add one kg of Epsom salt to it. Immerse yourself in the bath for 20 minutes, before going to bed. Take caution not to expose the body to a cold area after this. * In a bowl of water, soak 7 almonds and keep them overnight. Peel them and prepare a paste. Add this paste to lukewarm milk and drink it. * Take a bowl of water and soak 30 raisins in it, overnight. Chew them one by one, on an empty stomach, in the morning and have water. * Holy basil works effectively in curing low blood spserure. Take about 15 holy basil leaves and crush them. Filter the mixture with the help of a muslin cloth. Have this filtered mixture, along with a tsp of honey, on an empty stomach. * Include salt, asafoetida and fruits in your diet. All these are beneficial in restoring the blood spserure level. * Foods rich in proteins, vitamin C and vitamin B are effective in treating low blood spserure. * Exercises, light walking, swimming and cycling are beneficial in regulating the blood spserure level. Was this answer helpful?

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