Original Contributions
The normal difference in bilateral indirect blood pressure recordings in normotensive individuals*,**,*

Presented at the 2000 Annual Meeting of the American College of Emergency Physicians (ACEP) Research Forum, Philadelphia, PA, October 23-24, 2000 (abstr).
https://doi.org/10.1053/ajem.2001.20021Get rights and content

Abstract

If there is a significant dichotomy between bilateral blood pressure determinations in both arms, it is often taken as a sign of some type of underlying pathology. We wished to evaluate what the normal variation might be for significant differences between blood pressures in both arms. Significant difference was arbitrarily chosen as a systolic blood pressure value greater than 10 mm Hg. Bilateral indirect blood pressure determinations were obtained in 100 subjects with no known history of hypertension in the sitting position. The blood pressure was obtained by 2 observers, one who recorded the systolic and diastolic blood pressure as announced by the person taking the blood pressures who was blinded to the actual values taken. The coefficient of variation in obtaining the blood pressures in each arm was determined in 5 of the 100 subjects. The age, sex, and handedness of each individual were recorded as demographic variables. The average left and right systolic blood pressures were 112.1 ± 16.5 and 112.7 ± 16.3 mm Hg, respectively. The average left and right diastolic pressures were 64.4 ± 11.6 and 63.5 ± 9.9 mm Hg, respectively. There was no significant difference between left minus right systolic or diastolic differences (Student's paired t-test). There were no significant differences in systolic or diastolic blood pressure between gender or between right and left handed individuals (non-paired t-test). The average coefficients of variation for right and left arm systolic blood pressures were 5.41% and 5.81%, respectively. Fifteen subjects had differences in systolic blood pressure between both arms exceeding 10 mm Hg (7% to 22%, 95% confidence interval). Differences of more than 10 mm Hg in indirect bilateral blood pressure recordings are frequent in normotensive individuals and probably do not per se indicate any abnormal pathology. In the right clinical situation, differences that are noted should probably be repeated and should be added to the total clinical picture when used to determine whether a pathologic condition is present. (Am J Emerg Med 2001;19:43-45. Copyright © 2001 by W.B. Saunders Company)

Section snippets

Methods

The study was performed in the ambulatory care section of the adult emergency department (ED) of this institution. The study was presented to and waived for formal approval by the Institutional Review Board because of its simple and noninvasive nature. Before the study, each of 100 sequential random numbers from 0 to 9 was generated from a table of random numbers 8 with even being the left arm blood pressure taken first and odd being the right arm blood pressure taken first.

Each of 100 subjects

Results

A total of 100 consecutive accidental participants who agreed to the study over 1 day were enrolled. There were 49 women and 51 men with 11 left hand dominant and 89 right hand dominant individuals. The average age was 38.0 ± 11.5 years with a range from 19 to 73. The average age for the women and men was 38.4 ± 10.9 and 37.7 ± 12.2 years, respectively.

The mean left-right systolic difference was −0.59 with a 2-tailed P value of.5037 or not significant (NS). The mean left-right diastolic

Discussion

In a series of 100 known normotensive individuals who had random noninvasive blood pressure evaluations in both arms, 15% had a difference in blood pressure of greater than 10 mm Hg that was not related to gender differences or hand dominance. This value is consistent with previous studies5, 6, 7 and indicates the degree of variability present in unbiased blood pressure determinations. The average variability in systolic blood pressure determinations in this study was slightly greater than 5%,

References (8)

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Address reprint requests to Helen R. Pesola, RN, Department of Nursing, ICU, Hospital for Joint Disease, Orthopedic Institute, 17th and 1st Ave, New York, NY 10011. E-mail: [email protected]

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Am J Emerg Med 2001;19:43-45.

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0735-6757/01/1901-0011$10.00/0

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