Clark Christopher E
Clinical Lecturer, Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Smeall Building, St Luke's Campus, Magdalen Rd, Exeter, Devon EX1 2LU.
Curr Pharm Des. 2015;21(6):737-43. doi: 10.2174/1381612820666141024124349.
Differences in blood pressure measurements between arms are commonly encountered in clinical practice. If such differences are not excluded they can delay the diagnosis of hypertension and can lead to poorer control of blood pressure levels. Differences in blood pressure measurements between arms are associated cross sectionally with other signs of vascular disease such as peripheral arterial disease or cerebrovascular disease. Differences are also associated prospectively with increased cardiovascular mortality and morbidity and all cause mortality. Numbers of publications on inter-arm difference are rising year on year, indicating a growing interest in the phenomenon. The prevalence of an inter-arm difference varies widely between reports, and is correlated with the underlying cardiovascular risk of the population studied. Prevalence is also sensitive to the method of measurement used. This review discusses the prevalence of an inter-arm difference in different populations and addresses current best practice for the detection and the measurement of a difference. The evidence for clinical and for vascular associations of an inter-arm difference is presented in considering the emerging role of an inter-arm blood pressure difference as a novel risk factor for increased cardiovascular morbidity and mortality. Competing aetiological explanations for an inter-arm difference are explored, and gaps in our current understanding of this sign, along with areas in need of further research, are considered.
两臂血压测量值的差异在临床实践中很常见。如果不排除这种差异，可能会延迟高血压的诊断，并导致血压水平控制不佳。两臂血压测量值的差异与血管疾病的其他体征（如外周动脉疾病或脑血管疾病）存在横断面关联。差异还与心血管死亡率和发病率的增加以及全因死亡率存在前瞻性关联。关于两臂差异的出版物数量逐年上升，表明对该现象的兴趣日益浓厚。两臂差异的患病率在不同报告之间差异很大，并且与所研究人群的潜在心血管风险相关。患病率对所使用的测量方法也很敏感。本综述讨论了不同人群中两臂差异的患病率，并阐述了检测和测量差异的当前最佳实践。在将两臂血压差异视为心血管发病率和死亡率增加的新危险因素的新兴作用的背景下，介绍了两臂差异的临床和血管关联证据。探讨了两臂差异相互竞争的病因学解释，并考虑了我们目前对这一体征理解上的差距以及需要进一步研究的领域。
