Heart Research, Murdoch Children's Research Institute.
Department of Paediatrics, University of Melbourne.
J Hypertens. 2021 Jul 1;39(7):1341-1345. doi: 10.1097/HJH.0000000000002797.
An interarm difference (IAD) in blood pressure (BP) of 10 mmHg or more is a potential cardiovascular risk factor in adults, given its association with cardiovascular events/mortality. In children and adolescents, accurate BP assessment is critical for identifying risk of end organ damage. However, IAD has not been systematically studied in paediatric patients; if present and of significant magnitude, measuring BP in only one arm could lead to misclassification of hypertensive status.
In 95 children/adolescents with a normal aorta (including 15 with a history of tetralogy of Fallot) aged 7-18 years attending the Royal Children's Hospital, Melbourne, we aimed to determine the magnitude of IAD, frequency of IAD of at least 10 mmHg, difference in BP classification between arms, and influence of repeat measures on IAD in a single visit. After 5 min rest, simultaneous bilateral BP was measured in triplicate with an automated device.
Absolute systolic IAD was 5.0 mmHg (median, interquartile range 2-8 mmHg) and was 10 mmHg or more in 14%, with no change on repeat measures. In patients with a history of aortic surgery, IAD of 10 mmHg or more occurred in 27% (transposition of the great arteries, n = 15) and 75% (aortic coarctation, n = 8). Differences in BP classification, based on initial left vs. right arm measures, occurred in 25% (normal aorta) and 40%/63% (aortic surgery), or 17% and 33%/50%, respectively if second and third measurements were averaged.
Substantial interarm BP differences were common, even in apparently healthy children and adolescents: evaluation of IAD may, therefore, be important for BP classification in the paediatric setting.
成人血压（BP）的臂间差异（IAD）达到或超过 10mmHg 是潜在的心血管危险因素，因为它与心血管事件/死亡率相关。在儿童和青少年中，准确评估血压对于识别终末器官损伤的风险至关重要。然而，IAD 在儿科患者中尚未得到系统研究；如果存在且幅度较大，仅测量一只手臂的血压可能会导致高血压状态的分类错误。
在墨尔本皇家儿童医院就诊的 95 名年龄在 7 至 18 岁的具有正常主动脉（包括 15 名法洛四联症病史）的儿童/青少年中，我们旨在确定 IAD 的幅度、至少 10mmHg 的 IAD 频率、臂间 BP 分类差异，以及单次就诊中重复测量对 IAD 的影响。休息 5 分钟后，使用自动设备进行三次重复的双侧同步血压测量。
绝对收缩压 IAD 为 5.0mmHg（中位数，四分位距 2-8mmHg），14%的患者 IAD 达到或超过 10mmHg，重复测量时无变化。在主动脉手术患者中，10mmHg 或更高的 IAD 发生在 27%（大动脉转位，n=15）和 75%（主动脉缩窄，n=8）的患者中。基于初始左/右臂测量值的 BP 分类差异，在 25%（正常主动脉）和 40%/63%（主动脉手术）的患者中发生，或分别在 17%和 33%/50%的患者中，如果第二和第三次测量值取平均值。
即使在看似健康的儿童和青少年中，臂间 BP 差异也很常见：因此，IAD 的评估可能对儿科 BP 分类很重要。
