Annals of Long Term Care

Alvin B. Lin, MD, FAAFP

Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.

This month, February, has been set aside to focus our attention on heart disease. The President had his say, as required by law. And even Men's Health jumped into the foray by pointing out a study just published in Lancet demonstrating that a difference of 10-15mm Hg in blood pressure between one's arms is associated with an increase risk of heart disease and death. Over the last year since I started my practice, I've made a habit of checking blood pressure in both arms. But this was more for accuracy's sake than anything else. Rarely, actually never, did I find such a large difference in blood pressure readings.

But in reviewing 20 studies for their meta-analysis, the authors noted that non-invasive differences in blood pressure greater than 15 mm Hg were associated with peripheral vascular disease, cerebrovascular disease, cardiovascular mortality, and the most important all-cause mortality. Unfortunately, the sensitivity of this finding was rather low (which explains my lack of findings), so why waste the time (although specificity was noted to be quite high (good))?

If you ask me, the extra time it takes to obtain a second reading is well worth it. Why? How many of us get our blood pressure measured immediately after we sit down, before our pressures have had a chance to come down?  I doubt that too many staff members wait 3 to 5 minutes after seating their patient. That's why I check blood pressure after I've had a chance to chat with my patient for a while. So checking blood pressure in the other arm means a bit more time will have elapsed. Sure this might widen the gap. But if that's the case, recheck it again in the first arm. Better safe than sorry.