Blood pressure measurement: a call to arms

Our hard-pressed workforce may view the linked article by Clark and colleagues with a mixture of interest and trepidation. Their systematic review builds on earlier work to estimate the prevalence of inter-arm difference (IAD) in blood pressure (BP) in populations relevant to primary care. Pooled estimates of prevalence for systolic IAD of ≥10 mmHg were 11% in patients with hypertension, 7% for those with diabetes, and just under 4% in the general adult population. GPs are masters of distilling from their training and experience the shortest route to a clinical decision. This does not generally involve checking BP in both arms. Yet, paradoxically, this new evidence could reduce workload, because accurate identification of IAD in a minority of patients, and the exclusion of this condition in the majority, might inform a more rational and streamlined approach to blood pressure management in both groups.</p