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November 1, 1995

Measuring Blood Pressure: Which Arm?-Reply

Author Affiliations

Bristol-Myers Squibb Pharmaceutical Research Institute Princeton, NJ

JAMA. 1995;274(17):1343. doi:10.1001/jama.1995.03530170023017

In Reply.  —Dr Panayiotou's group notes that BP inequality between arms can be clinically important and suggests a prevalence of 23%.1 Studies earlier in this century using non-simultaneous readings reported interarm differences of greater than 10 mm Hg systolic in about 20% to 50% of patients, whereas simultaneous readings suggested a markedly lower prevalence, 2.6% to 17%.2 In their article1 Panayiotou's group cites Harrison et al,2 whose single, immediately sequential noninvasive readings suggested that 26.6% of 454 subjects had such a difference; however, when two observers obtained three simultaneous readings (same heartbeats, cuffs connected by a T tube), only 5.3% of subjects showed this degree of discrepancy.2 Adding invasive measurements approximately halved the prevalence, and just one patient showed a consistent difference. More recently, Hashimoto et al3 also observed 28% to have a difference in systolic BP of greater than 8 mm Hg. However,

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