Singer A J, Hollander J E
Department of Emergency Medicine, University Medical Center, State University of New York, Stony Brook, USA.
Arch Intern Med. 1996 Sep 23;156(17):2005-8. doi: 10.1001/archinte.156.17.2005.
Although a large interarm blood pressure difference is assumed to help identify patients with aortic dissection, the degree of normal interarm blood pressure variation has not been well defined.
To determine the normal variation in bilateral upper-extremity blood pressure measurements, we conducted a prospective observational study on a convenience sample of ambulatory patients who were seen at a university hospital emergency department. Bilateral upper-extremity blood pressure measurements were performed with an automated blood pressure monitor at the time the patient was seen. Clinical and demographic data collected included age, sex, race, medical history, chief complaint, cardiac risk factors, pulse, bilateral blood pressure measurements, and discharge diagnosis. The primary outcome measures were the interarm blood pressure differences.
Of 610 patients, 324 (53%) had a systolic or a diastolic interarm blood pressure difference of more than 10 mm Hg, and 113 (19%) had a systolic or a diastolic interarm blood pressure difference of more than 20 mm Hg. The variation in interarm blood pressure measurements was unrelated to age, gender, race, mean arterial pressure, cardiovascular risk factors, or discharge diagnosis. The mean interarm systolic blood pressure difference was significantly greater in patients with known coronary artery disease (14.5 vs 10.4 mm Hg; P = .05, Student t test).
Bilateral upper-extremity blood pressure determinations, as measured by automated indirect measurement, have a wide degree of interarm variation.
尽管双臂血压差异大被认为有助于识别主动脉夹层患者，但正常双臂血压的变化程度尚未得到明确界定。
为确定双侧上肢血压测量的正常变化，我们对一家大学医院急诊科的门诊患者便利样本进行了一项前瞻性观察研究。在患者就诊时，使用自动血压监测仪测量双侧上肢血压。收集的临床和人口统计学数据包括年龄、性别、种族、病史、主要症状、心脏危险因素、脉搏、双侧血压测量值以及出院诊断。主要结局指标为双臂血压差异。
610例患者中，324例（53%）双臂收缩压或舒张压差异超过10 mmHg，113例（19%）双臂收缩压或舒张压差异超过20 mmHg。双臂血压测量值的变化与年龄、性别、种族、平均动脉压、心血管危险因素或出院诊断无关。已知患有冠状动脉疾病的患者双臂收缩压平均差异显著更大（14.5对10.4 mmHg；P = 0.05，学生t检验）。
通过自动间接测量法测定的双侧上肢血压存在较大的双臂间差异。
