Right- and left-arm blood pressure discrepancies in vascular surgery patients

To identify a relationship between atherosclerotic vascular disease and differences in blood pressure between the right and left arms, blood pressure differences between arms were measured in patients with peripheral vascular disease (PVD, n = 58), in patients with coronary artery disease (CAD, n = 38), and in patients with no evidence of atherosclerotic disease, who served as a control group (n = 38). The incidence and magnitude of right and left arm pressure difference determined by the oscillometric technique were compared between the patient groups. The incidence of systolic pressure difference ≥20 mmHg between arms in patients with PVD (21%) was greater than that in either those with CAD (3%) (P ≤0.05) or control subjects (0%) (P < 0.01). The incidence of systolic pressure difference ≥ 45 mmHg between arms in patients with PVD (10%) was greater than that in either those with CAD (0%) (P < 0.05) or control subjects (0%) (P < 0.05). Patients with PVD also had a greater incidence of right and left arm difference than did those with CAD or controls for mean and diastolic blood pressures. Of all patients with a systolic difference greater than 10 mmHg, neither the right nor the left arm blood pressure was consistently higher: 21 of 35 (60%) had a higher pressure in the right arm, and 14 of 35 (40%) had a higher pressure in the left arm (P = 0.33). Gender, diabetes, hypertension, smoking, and age were not associated with a difference in blood pressure between the right and left arms. The PVD group was divided according to clinical presentation of atherosclerotic lesions. These subgroups then were compared regarding blood pressure difference between arms. Patients with carotid disease and combined carotid/CAD had the highest mean systolic pressure differences (18 and 26 mmHg respectively), both of which were significantly higher than in controls (5 mmHg) (P ≤ 0.001). The findings indicate that patients with PVD have a high incidence and magnitude of right- and left-arm blood pressure discrepancies compared to patients with coronary disease alone or those without atherosclerotic disease. The authors suggest the measurement of blood pressure in both arms in patients with PVD when diagnostic and therapeutic decisions are made.