Key result
A systolic inter-arm blood pressure difference ≥ 15 mmHg was not associated with all-cause mortality in vascular surgical patients (HR 1.03; 95% CI 0.78-1.36; p=0.84).
Why the study?
Does a systolic inter-arm difference ≥ 15 mmHg predict all-cause mortality in vascular surgical patients?
Cohort (n=898)
Does a systolic inter-arm difference ≥ 15 mmHg predict all-cause mortality in vascular surgical patients?
Hazard Ratio: 1.03 (95% CI 0.78–1.36)
p-value: p=0.84
Large inter-arm blood pressure differences are common in vascular surgical patients and pose a risk for monitoring errors, but a systolic difference ≥ 15 mmHg does not predict medium-term mortality.
No association with mortality suggests inter-arm BP difference ≥15 mmHg should not guide risk stratification in vascular surgery; leaves open effects on monitoring accuracy.
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)].
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Durrand et al. (2013) conducted a cohort in Vascular surgical patients (n=898). Systolic inter-arm difference ≥ 15 mmHg vs. Systolic inter-arm difference < 15 mmHg was evaluated on All-cause mortality (HR 1.03, 95% CI 0.78-1.36, p=0.84). A systolic inter-arm blood pressure difference ≥ 15 mmHg was not associated with all-cause mortality in vascular surgical patients (HR 1.03; 95% CI 0.78-1.36; p=0.84).
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