Hypertension guidelines

摘要

We were interested to read Parker and Glasziou's assessment of previous hypertension guidelines and their advice on the measurement of both arms, to identify an inter-arm difference.1 We have also researched this subject,2 and found that the advice to measure both arms can be traced back, almost verbatim, over 70 years.3 The ESH 2007 guidelines, however, took a significant step in attributing an inter-arm difference to peripheral vascular disease for the first time.4 Unfortunately, the weight of evidence supporting this statement was not assessed in that guideline, exemplifying Parker and Glasziou's argument. We have sought clarification of this evidence, but requests to the guideline's authors have not received a response. Consequently, we have been conducting our own systematic review of the evidence associating an inter-arm difference with peripheral vascular disease. Preliminary results of our meta-analysis suggest a significant association of a systolic inter-arm difference >10 mmHg or >15 mmHg with peripheral vascular disease (OR = 5.25, 95% CI = 2.85 to 9.70 and OR = 6.46, 95% CI = 4.85 to 8.61 respectively, both P<0.001). Seemingly this is exactly the sort of evidence base to justify measuring both arms, but all studies included in the analysis were of populations at existing high vascular risk, for example, referrals to angiography services. We cannot discover an evidence base that permits extrapolation of the guideline statement to the general population of which it is aimed.