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Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter?
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  • Published on:
    Response to Interarm BP difference
    • Sau Nga FU, GP Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority
    • Other Contributors:
      • Bernard Man Yung Cheung, Professor

    Thank you for your valuable comments on our paper. According to the British and Irish Hypertension Society and the American Heart Association, clinicians should measure patients' blood pressure (BP) in both arms to diagnose possible cardiovascular anomalies and select the higher BP arm for subsequent measurement.1 The clinician is recommended to document patients' BP differences in both arms. Cardiovascular risks could be controlled more tightly when there is a persistent discrepancy of more than 15mmHg. Patients should be told which arm to use for future measurements.
    In our study, all participants had BP measured in both arms by the nurses upon recruitment. The arm with higher BP was documented and used in subsequent clinical and home BP measurements. Clinic nurses checked if participants had selected the correct arm at follow-up six weeks later.

    Conflict of Interest:
    None declared.
  • Published on:
    Interarm difference in blood pressure

    It is axiomatic that , on initial assessment of a patient's blood pressure(BP), measurement should be recorded in both arms, and the higher of the two readings should be used for diagnosis and management(1). I would add that the arm with the higher blood pressure should be the arm from which home blood pressures are measured.

    Was that requirement fulfilled in the study evaluating knowledge and practice of home blood pressure monitoring?

    Awareness of interarm blood pressure informs the technique of blood pressure measurement. It also adds information about prognosis given the observation that "Every 10 mm Hg difference in systolic BP between arms conferred a mortality hazard of 1.24(95% Confidence Interval 1.01 to 1.52 after adjusting for average systolic BP and chronic kidney disease"(2). Arguably, the rationale for this observation comes from the meta analysis which showed that a difference of 15 mm Hg or more in systolic BP is associated with cerebrovascular disease and with peripheral vascular disease, and increased cardiovascular mortality, respectively(3).

    References

    (1) Giles TG., Egan P
    Inter-arm difference in blood pressure may have serious research and clinical implications
    The Journal of Clinical Hypertension 2012;14:491-492
    (2) Agarwal R., Bunaye Z., Bekele DM
    Prognostic significance of bwteen-arm blood pressure differences
    Hypertension2008;51:657-662
    (3)Clark CE., taylor R., Shore...

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    Conflict of Interest:
    None declared.