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A difference in systolic blood pressure between arms is an easy outcome was developed to determining physical status and related to vascular disease. The purpose of this cross-sectional study was to investigate the prevalence of vascular impairment which assessed by the determination of inter-arm systolic blood pressure difference among the elderly patient in Kham Khuean Kaeo Hospital, Yasothon province. The study was conducted from April to December 2018, one hundred forty elderly participants were enrolled from hypertension clinic, Kham Khuean Kaeo Hospital. Sequential bilateral blood pressure measurement was recorded by random order, the average of the three measurements in each arm was used for analysis. In the present study, the absolute value of systolic blood pressure value between right and left arm was reported [systolic blood pressure of higher arm - systolic blood pressure of lower arm]. The data were analyzed using descriptive statistics. Correlation of inter-arm systolic blood pressure difference and demographic characteristics were assessed with Pearson’s correlation coefficient. The study group included 140 individuals, average age 72.44 ± 6.22 years, 70 men (50.00%). Most of the subjects were right -handed. The prevalence of vascular impairment was 35.71% and 7.85%, according to the cut point of inter-arm systolic blood pressure difference ³ 5 and ³ 10 mmHg, respectively. Higher resting diastolic blood pressure, resting systolic blood pressure and lower mid-arm circumference were associated with lager inter-arm systolic blood pressure difference. These findings support the importance of blood pressure measurement in both arms following Hypertension Society recommendation. Moreover, inter-arm systolic blood pressure difference also useful as a simple tool for vascular screening in the community elderly.
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2. Weinberg I, Gona P, O'Donnell CJ, Jaff MR, Murabito JM. The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study. The American journal of medicine. 2014; 127(3):209-15.
3. Hwang HJ, Sohn IS, Kim DH, Park CB, Cho JM, Kim CJ. Increased interarm blood pressure difference is associated with autonomic dysfunction and atherosclerosis in patients with chest pain and no history of coronary artery disease. International journal of cardiology. 2017; 241:25-9.
4. Tanaka Y, Fukui M, Tanaka M, Fukuda Y, Mitsuhashi K, Okada H, et al. The inter-arm difference in systolic blood pressure is a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes. Hypertension research: official journal of the Japanese Society of Hypertension. 2014; 37(6): 548-52.
5. Singh S, Sethi A, Singh M, Khosla K, Grewal N, Khosla S. Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis. Journal of the American Society of Hypertension: JASH. 2015; 9(8):640-50 e12.
6. Clark CE, Taylor RS, Butcher I, Stewart MC, Price J, Fowkes FG, et al. Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk. The British journal of general practice: the journal of the Royal College of General Practitioners. 2016; 66(646):e297-308.
7. Fonseca-Reyes S, Forsyth-MacQuarrie AM, Garcia de Alba-Garcia JE. Simultaneous blood pressure measurement in both arms in hypertensive and nonhypertensive adult patients. Blood pressure monitoring. 2012; 17(4):149-54.
8. Kimura A, Hashimoto J, Watabe D, Takahashi H, Ohkubo T, Kikuya M, et al. Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan. Journal of hypertension. 2004; 22(12): 2277-83.
9. Rosenberger J, McCrudden S, McCullough C, Wang L, Kime J, Albert NM. Factors associated with inter-arm blood pressure differences in patients admitted to critical care units. Heart & lung: the journal of critical care. 2018; 47(2):100-6.
10. Lane D, Beevers M, Barnes N, Bourne J, John A, Malins S, et al. Inter-arm differences in blood pressure: when are they clinically significant? Journal of hypertension. 2002; 20(6):1089-95.
11. Heneghan C, Perera R, Mant D, Glasziou P. Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence. The British journal of general practice: the journal of the Royal College of General Practitioners. 2007;57(545):948-52.
12. Sugawara J, Hayashi K, Yokoi T, Cortez-Cooper MY, DeVan AE, Anton MA, et al. Brachial-ankle pulse wave velocity: an index of central arterial stiffness? Journal of human hypertension. 2005; 19(5): 401-6.
13. Fortier C, Agharazii M. Arterial Stiffness Gradient. Pulse (Basel). 2016; 3(3-4): 159-66.
14. Ostchega Y, Hughes JP, Zhang G, Nwankwo T, Chiappa MM. Mean mid-arm circumference and blood pressure cuff sizes for U.S. adults: National Health and Nutrition Examination Survey, 1999-2010. Blood pressure monitoring. 2013; 18(3): 138-43.
15. Iida M, Ishiguro Y, Ueda N and Honjo H. Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension. Blood Pressure Monitoring 2020: 25:26–33
16. Sharma B, Ramawat P. Prevalence of inter-arm blood pressure difference among clinical out-patients. International journal of health sciences. 2016; 10(2): 229-37.
17. Verberk WJ, Kessels AG, Thien T. Blood pressure measurement method and inter-arm differences: a meta-analysis. American journal of hypertension. 2011; 24(11):1201-8.
18. Karagiannis A, Tziomalos K, Krikis N, Sfikas G, Dona K, Zamboulis C. The unilateral measurement of blood pressure may mask the diagnosis or delay the effective treatment of hypertension. Angiology. 2005; 56(5): 565-9.
19. Nakmareong S, Mato L, Janyachareon T, Thamnithis P, Artchaithon P. Relationship between muscular flexibility and inter-arm systolic blood pressure difference in healthy subjects. Journal of Nursing and Health Care. 2016; 34(4): 53-62.
20. Nakmareong S, Worachet S, Mato L, Janyachareon T, Luangaram S. Isometric handgrip training alleviated an inter-arm blood pressure difference and incidence of impaired vascular properties in prehypertensive adults. Journal of Medical Technology and Physical Therapy. 2017; 29(1): 77-86.
21. Kranenburg G, Spiering W, de Jong PA, Kappelle LJ, de Borst GJ, Cramer MJ, et al. Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease. Int J Cardiol. 2017; 244: 271-6.
22. Ma W, Zhang B, Yang Y, Qi L, Meng L, Zhang Y, et al. Correlating the relationship between interarm systolic blood pressure and cardiovascular disease risk factors. J Clin Hypertens (Greenwich). 2017; 19(5): 466-71.
23. Clark CE, Aboyans V. Interarm blood pressure difference: more than an epiphenomenon. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2015; 30(5): 695-7.
24. Clark CE, Taylor RS, Shore AC, Campbell JL. Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners. 2016; 66(652): e838-e47.
25. Karagiannis A, Tziomalos K, Krikis N, Sfikas G, Dona K, Zamboulis C. The unilateral measurement of blood pressure may mask the diagnosis or delay the effective treatment of hypertension. Angiology. 2005; 56(5): 565-9.
26. Loenneke JP, Loprinzi PD, Abe T, Thiebaud RS, Allen KM, Grant Mouser J, et al. Arm circumference influences blood pressure even when applying the correct cuff size: Is a further correction needed? International journal of cardiology. 2016; 202: 743-4.