project 512 | Translating inter-arm blood pressure difference measurement into practice

A difference in the blood pressure (BP) measured in the left and right arms can suggest that an individual has an increased chance of heart disease or early death. At the moment doctors and nurses do not routinely measure BP in both arms. This may be partly because they do not know what to do on finding a difference, but there are likely to be other factors, such as concerns over extra workload, that also prevent measurement. By recognising this difference in BP between arms, doctors and nurses can make more informed decisions with patients about treatment for high blood pressure. We propose to design and develop a funding application for a study of inter-arm difference measurement in primary care.

We will undertake some analysis of existing data, to gain some background information as to how the study might work and how to measure its effect. The main task will then be to design a study to test how an inter-arm difference in BP can best be used in primary care to help in cardiovascular risk assessment, thus improving on the present arrangements adopted within the NHS. It is proposed that such an assessment would be used to help guide better decisions about BP management. This study will investigate the benefits of a comprehensive cardiovascular risk assessment (which will include measuring differences in BP between arms, and other factors) and compare that approach with people receiving usual primary care. It will also include interviews with doctors and nurses about their attitudes to and experiences of measuring blood pressure in both arms. The work proposed here will result in an outline submission for study funding.