Inter arm blood pressure difference: an indicator of cardiovascular risk

Background: Overall prevalence of hypertension in India is 33% in urban and 25% in rural areas. For optimal health blood pressure of less than 120 mm of Hg systolic and 80mm of Hg diastolic is to be maintained. According to American heart association, inter arm BP difference of more than 20 mm of Hg systolic and 10 mmm of Hg diastolic are associated with peripheral vascular disease, vasculitis, connective tissue disorders and congenital anomalies. Though the guidelines quote that it is mandatory to examine pressure in both arms before diagnosing hypertension this system is not followed, which has led to increase in misdiagnosis of HT. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of HT and BMI is related to higher interarm difference.Methods: 110 normal healthy medical students both males & females are recruited for the study .after obtaining institutional ethical clearance the participants in the study are informed about the study process and detailed history obtained .after 5 min of rest BP is assessed by sphygmomanometer first in right arm & then left. Statistical analysis done using paired t test, correlation between variables done with chi square test. Results: statistically significant difference p<0.0001 noted in interarm systolic and diastolic bp ,which shows that pressure difference exists between two arms hence it is mandatoty to assess bp in both arms and the higher of the two is taken as normal .subjects with family history of hypertension had interarm sytolic bp >10mm of Hg and diastolic interarm >5mm of Hg ,though this value is not statistically significant ,it shows that people with family history of hypertension is more prone to interarm BP difference.Conclusions: Interarm difference exists in norma lhealthy volunteers and interarm difference of >10 mm of Hg systolic & >5 mm of Hg diastolic should be investigated further as these subjects are more prone to develop cardiovascular morbidities .hence we conclude that interarm difference is a sensitive noninvasive and simple method of detecting individuals prone for cardiovascular morbidities.