Factors associated with inter-arm blood pressure differences in patients admitted to critical care units

Abstract

Background: Experts recommend obtaining one-time dual- (inter)-arm blood pressure (BP) measurements to predict cardiovascular morbidity risk.

Objectives: To determine differences in inter-arm systolic (S)/diastolic (D) BPs obtained simultaneously and sequentially and examine associations between patient factors and clinical outcomes and inter-arm BP differences.

Method: A comparative study of adults treated in intensive care; multivariable logistic models were created to determine the extent that inter-arm BP differences predicted outcomes.

Results: Of 427 adults in intensive care units, 31.8% had differences of >10 mmHg on simultaneous measurement and 35.1% had differences of >10 mmHg on sequential measurement; differences >15 mmHg were 17.9% and 19.8%, respectively. After controlling for patient factors, simultaneous inter-arm DBP differences >15 mmHg were associated with shorter hospital and longer intensive care length of stay (p = 0.031 and 0.029, respectively) and a 79% reduction in the likelihood of discharge to home (p = 0.009).

Conclusions: Simultaneous inter-arm DBP differences >15 mmHg were associated with clinical outcomes.

Keywords: Diastolic BP; Discharge home; Inter-arm oscillometric blood pressure measurement; Length of hospital stay; Simultaneous inter-arm blood pressures; Systolic BP measurement.