44
per cent of patients being treated for high blood pressure and who took part in
the study either suffered vascular disease or died over a 10-year period
In January a research team from the Peninsula
College of Medicine and Dentistry reported the first systematic review of
findings related to the risk factors associated with a difference in blood
pressure between arms.
The first study, which was published in The Lancet,
suggested that a difference of more than 10mmHg or 15mmHg in systolic blood
pressure (the ‘top’ reading) was an indicator of increased risk of vascular
disease and mortality.
The second study looks at data from patients over a
10-year period. The findings of the study support that of the first – that
there is a link between a difference in blood pressure between arms and
vascular disease and mortality – and further emphasise the need for two-arm
blood pressure checks to become the norm.
Measurements for the study were carried out at The
Mid Devon Medical Practice in Witheridge, Devon where Dr. Christopher Clark,
lead author of both studies, is a GP.
The study followed up 230 patients receiving
treatment in the practice for hypertension. Two-arm blood pressure readings
were taken from participating patients at the start of the study during three
successive surgery attendances and they were then followed for 10 years.
Of the 230 patients, 24 percent had a difference
between the arms in systolic blood pressure measurements of more than 10mmHg
and nine per cent registered a difference of more than 15mmHg.
From the authors’ previous review, a difference of
10mmHg indicates an increased risk of peripheral vascular disease (the
narrowing and hardening of the arteries that supply blood to the legs and
feet). A difference of 15mmHg or more is associated with increased risk of
peripheral vascular disease; pre-existing cerebrovascular disease (affecting
the blood supply to the brain and often associated with conditions such as
dementia); and mortality, both as a result of cardiovascular problems and generally.
By carrying out a study over 10 years, the research
team was able to assess the impact of an inter-arm difference in blood pressure
over a longer period of time and so witness the long-term effect on patients’
health. During the study period 52 cardiovascular and 27 cerebrovascular events
occurred in 76 patients.
Fifty-nine patients died and a total of 100, 44 per
cent of the total participating number, either suffered a cardiovascular or
cerebrovascular event, or died.
Dr. Christopher Clark commented: "Our 10-year
follow-up on hypertensive patients has for the first time shown in a primary
care setting that, over time, an interarm difference in systolic blood pressure
of 10 mm Hg or more or 15 mm Hg or more predicts reduced mortality and event
free survival. The risk of a first vascular event, in the presence of an
interarm difference, appears to be as great as that found in patients with
pre-existing cardiovascular disease."
He added: "This study supports the potential
value of an interarm difference as a simple clinical indicator of increased
cardiovascular risk. Assessment of blood pressure in both arms is recommended
by guidelines and should become a core component of initial blood pressure
measurement in primary care. Detection of an inter-arm difference should prompt
consideration of further vascular assessment and aggressive management of risk
factors."
Professor John Campbell, Professor of General
Practice and Primary Care at Peninsula College of Medicine and Dentistry said:
"This study highlights the vital importance of carefully conducted
clinical research derived from community based settings. Nearly one-million
consultations take place each day in GP surgeries and practices. UK general
practitioners are in a unique position to identify and follow-up cohorts of
their patients over extended periods of time using their personal knowledge of
patients and their families, and drawing on the availability of high quality
clinical records in UK primary care settings.
This is a prime example of the benefit of providing
continuous care for patients over a period of time acting as the basis for
important clinical research, and highlights the importance of addressing
clinically relevant questions generated by health professionals delivering care
at the coal-face. We hope the results will be used to develop further research
examining exactly how the findings can best be used to inform evidence-based
care for NHS patients in the UK."
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