ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners2013
Inter-arm blood pressure differences compared with ambulatory monitoring: a manifestation of the 'white-coat' effect?
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019.Arquivos brasileiros de cardiologia · 2019Guideline
- Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Pooled it
- Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Trial
- Inter-arm difference in blood pressure in patients referred to tertiary hypertension center: Prevalence, risk factors, and relevance to physicians.Journal of clinical hypertension (Greenwich, Conn.) · 2020Article
- Usefulness of four-limb blood pressure measurement in prediction of overall and cardiovascular mortality in acute myocardial infarction.International journal of medical sciences · 2020Article
- Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study.American journal of hypertension · 2017Observational
- A study of the VaSera arterial stiffness device in US patients.Journal of clinical hypertension (Greenwich, Conn.) · 2017Article
- The interarm blood pressure difference: Do we know enough yet?Journal of clinical hypertension (Greenwich, Conn.) · 2017Article
- The diagnostic value of supine blood pressure in hypertension.Archives of medical science : AMS · 2016Article
- Prevalence of inter-arm blood pressure difference among clinical out-patients.International journal of health sciences · 2016Article
- Review
- Long-term evolution of renal function in patients with type 2 diabetes mellitus: a registry-based retrospective cohort study.BMJ open · 2013Article
- Inter-arm blood pressure differences compare with ambulatory monitoring: a manifestation of the 'white-coat' effect?The British journal of general practice : the journal of the Royal College of General Practitioners · 2013Article
- Authors' response.The British journal of general practice : the journal of the Royal College of General Practitioners · 2013Article
Corrections and comments
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundInter-arm difference in blood pressure of >10 mmHg is associated with peripheral vascular disease, but it is unclear how much of the difference in sequential right and left arm blood pressure measurements might be due to a 'white-coat' effect.
aimTo use ambulatory blood pressure monitoring (ABPM) to better understand the clinical significance of inter-arm differences in blood pressure. DESIGN AND
settingRetrospective study in a teaching hospital in Birmingham.
methodAnonymised clinical data collected from 784 patients attending a single hospital-based hypertension clinic were retrospectively analysed. Each participant had blood pressure measured sequentially in both arms, followed by ABPM over the subsequent 24 hours.
resultData were available for 710 (91%) patients, of whom 39.3% (279) had a blood pressure difference of 10 mmHg or more between each arm. Compared to daytime systolic ABPM, the difference was 25.1 mmHg using the arm with the highest reading, but only 15.5 mmHg if the lower reading was taken (mean difference 9.6 mmHg (95% confidence interval [CI] = 9.0 mmHg to 10.3 mmHg)). However, differences between mean right (20.7 mmHg) or left (19.9 mmHg) arm blood pressure and daytime systolic ABPM were very similar.
conclusionCompared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure. As there is no significant difference in the extent of disparity with ABPM by left or right arm, this is unlikely to be due to arm dominance and may be due to the 'white-coat' effect reducing blood pressure on repeated measurement. Where a large inter-arm blood pressure difference is detected with sequential measurement, healthcare professionals should re-measure the blood pressure in the original arm.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.