ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 21
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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Impact of measuring blood pressure in both arms on
hypertension and cardiovascular risk assessment:
The ECHORN cohort study
A/Prof Oswald Peter Adams1, Deron Galusha2, Josefa Martinez-Brockman2, Dr Euclid Morris1,
Rohan Maharaj3, Cruz Nazario4, Maxine Nunez5, Marcella Nunez-Smith2
1
The University of the West Indies, Cave Hill Campus, 2Yale School of Medicine, 3The University of the
West Indies, St. Augustine Campus, 4University of Puerto Rico, Medical Sciences Campus, 5University
of the Virgin Islands, School of Nursing
Introduction
Guidelines recommend measuring blood pressure (BP) in both arms and using the arm with the higher
BP. Few family physicians do this. We aimed to determine the impact of measuring BP in both arms on
hypertension and atherosclerotic cardiovascular disease (ASCVD) risk classification.
Methods
Residents ≥40 years of age on the Caribbean islands or Barbados, Puerto Rico, Trinidad and the US
Virgin Islands were recruited to a cohort study. A survey was completed, HbA1c, glucose and lipid
tests done and BP was measured in both arms simultaneously after the participant had been seated
for five minutes. Recorded BP was the average of three readings taken one minute apart.
Results
Of 2912 participants (mean age 57.2 years, 65.0% female, mean BMI 29.2 kg/m2) with valid BP
measurements, 1204 (41.4%) were on antihypertensive medication and 452 (15.6%) reported a heart
condition. The interarm systolic BP difference was ≥5, ≥10 and ≥15 mmHg in 1080 (37.1%), 312
(10.7%) and 95 (3.3%) participants, respectively. In 26.2% of participants, higher systolic and diastolic
BP were in different arms. Mean differences between the higher and lower systolic and diastolic BP
readings were 4.5 mmHg (137.6 vs 133.1 mmHg; P < 0.0001) and 3.1 mmHg (81.9 vs 78.8 mmHg;
P < 0.0001), respectively. Higher versus lower arm systolic BP would reclassify 299 (10.3%) and 241
(8.3%) participants at the 130- and 140-mmHg cut-offs, respectively. For diastolic BP, 316 (10.9%)
and 202 (6.9%) participants would be reclassified at the 80- and 90-mmHg cut-offs. Using the higher
versus lower systolic BP, the ASCVD 10-year risk score would be ≥7.5% in 41.7% versus 40.0% of
participants, respectively (P < 0.0001).
Discussion
Measuring BP in both arms is needed for accurate hypertension diagnosis, BP control assessment
and to identify the 10.7% of people with a ≥10-mmHg interarm systolic difference.
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