February is American Heart Month

This month, February, has been set aside to focus our attention on heart disease.  The President had his say, albeit yesterday, 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 15mm 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 2nd 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 3-5 minutes after seating their patient.  That's why I check blood pressure after I've had a chance to chat w/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.

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