Inter-arm systolic blood pressure (BP) differences (sIADs) have recently been recognized as a risk factor for cardiovascular mortality. However, sIAD reproducibility remains unresolved from a controlled trial perspective. We evaluated the between-visit reproducibility of sIADs in hypertensive patients. We examined 1875 hypertensive participants aged 20 years and older (mean age: 62.3 years, 45.4% female) from nine primary clinics and 27 secondary and tertiary hospitals. The BPs in both arms were automatically and simultaneously measured in triplicate with a cuff-oscillometric BP device. BP measurements were obtained at baseline and at 3-month follow-up time points. Increased sIAD was defined as an absolute difference of ⩾10 mm Hg in the average systolic BPs between the left and right arms. The overall mean sIAD was 4.33±4.17 mm Hg. The prevalences of increased sIAD at baseline and at the 3-month measurements were 7.6% and 7.1%, respectively. The intraclass correlation coefficient for the between-visit sIADs was 0.304 (95% confidence interval (CI) 0.262–0.344). The κ-value between the baseline and follow-up increased sIADs was 0.165 (95% CI 0.096–0.234). The percentage of patients who exhibited an increased sIAD at 3 months compared with the initially increased sIAD at baseline was 21.8%. The reproducibility of sIAD determination between baseline and the 3-month follow-up measurements lacked agreement in the hypertensive patients. Further studies should identify the relevant variables and characteristics of this poor reproducibility (CRIS number; KCT0001235).
Subscribe to Journal
Get full journal access for 1 year
only $24.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderrisi M, Grobbee D, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Simes PA, Sleight P, Viigimaa M, Waeber B, Zannad F . ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159–2219.
Ogihara T, Kikuchi K, Matsuoka H, Fujita T, Higaki J, Horiuchi M, Imai Y, Imaizumi T, Ito S, Iwao H, Kario K, Kawano Y, Kim-Mitsuyama S, Kimura G, Matsubara H, Matsuura H, Naruse M, Saito I, Shimada K, Shimamoto K, Suzuki H, Takishita S, Takahashi N, Tsuchihasi T, Uchiyama M, Ueda S, Ueschima H, Umemura S, Ishimitsu T, Rakugi H . The Japanese Society of Hypertension Committee for Guideline for the Management for Hypertension. Hypertens Res 2009; 32: 3–107.
Verberk WJ, Kessels AG, Thien T . Blood pressure measurement method and inter-arm differences: a meta-analysis. Am J Hypertens 2011; 24: 1201–1208.
Clark CE, Campbell JL, Evans PH, Millward A . Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review. J Hum Hypertens 2006; 20: 923–931.
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. J Am Soc Hypertens 2015; 9: 640–650.
Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL . Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet 2012; 379: 905–914.
Tanaka Y, Fukui M, Tanaka M, Yukiko F, Kazuteru M, Hiroshi O, Masahiro Y, Goji H, Keiji Y, Naoto N . The inter-arm difference in systolic blood pressure is a novel risk marker for subclinical atherosclerosis in patients with type 2 diabetes. Hypertens Res 2014; 37: 548–552.
Clark CE, Taylor RS, Shore AC, Campbell JL . The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ 2012; 344: e1327.
Cao K, Xu J, Shangguan Q, Hu W, Li P, Cheng X, Su H . Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: an updated meta-analysis of cohort studies. Int J Cardiol 2015; 189: 211–219.
James GD, Pickering TG, Yee LS, Harshfield GA, Riva S, Laragh JH . The reproducibility of average ambulatory, home, and clinic pressures. Hypertension 1988; 11: 545–549.
Agarwal R, Bunaye Z, Bekele DM . Prognostic significance of between-arm blood pressure differences. Hypertension 2008; 51: 657–662.
Eguchi K, Yacoub M, Jhalani J, Gerin W, Schwartz JE, Pickering TG . Consistency of blood pressure differences between the left and right arms. Arch Intern Med 2007; 167: 388–393.
Sun H, Li P, Su H, Wang j, Hu W, Li J, Liu Y, Cheng X . The detection rates of inter-arm systolic blood pressure difference vary with blood pressure levels in hypertensive patients under antihypertensive therapy. Int J Cardiol 2014; 172: e419–e420.
Grossman A, Weiss A, Beloosesky Y, Morag-Koren N, Green H, Grossman E . Inter-arm blood pressure difference in hospitalized elderly patients—is it consistent? J Clin Hypertens 2014; 16: 518–523.
Miller WG, Tate JR, Barth JH, Jones GR . Harmonization: the sample, the measurement, and the report. Ann Lab Med 2014; 34: 187–197.
Giles TD . Inter-arm difference in systolic blood pressure-'the plot stiffens'. J Clin Hypertens 2013; 15: 878–879.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ . Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45: 142–161.
Kimura A, Hashimoto J, Watabe D, Takahashi H, Ohkubo T, Kikuya M, Imai Y . Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan. J Hypertens 2004; 22: 2277–2283.
Stergiou GS, Lin CW, Lin CM, Chang SL, Protogerou AD, Tzamouranis D, Nasothimiou E, Tan TM . Automated device that complies with current guidelines for office blood pressure measurement: design and pilot application study of the Microlife WatchBP Office device. Blood Press Monit 2008; 13: 231–235.
This study was funded by the Korean National Strategic Coordinating Center for Clinical Research.
The authors declare no conflict of interest.
About this article
Cite this article
Kim, J., Kim, E., Namgung, J. et al. Between-visit reproducibility of inter-arm systolic blood pressure differences in treated hypertensive patients: the coconet study. Hypertens Res 40, 483–486 (2017). https://doi.org/10.1038/hr.2016.173
- Inter-arm blood pressure
- Risk factor
Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study
British Journal of General Practice (2020)
The Future Alert of Inter-Arm Blood Pressure Difference Among Young Healthy Population: A Cross-Sectional Study. (Preprint)
Journal of Medical Internet Research (2020)
Clinical Physiology and Functional Imaging (2019)
Hypertension Research (2019)