Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV

Williams, Bryan; Nr, Poulter; Mj, Brown; Davis, Mark; McInnes, GT; Potter, JF; Sever, PS; Thom, Simon

doi:10.1038/sj.jhh.1001683

Cited by 1,036 publications

(800 citation statements)

References 323 publications

(320 reference statements)

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“…The arm with the higher values should be used for subsequent measurements '. 9 This appears to be guidance repeated almost verbatim through previous versions [10][11][12][13][14] stretching back over 60 years. 15 The guidelines do not consider the prevalence of the IAD and suggest that differences X20 mm Hg systolic and/or 10 mm Hg diastolic warrant specialist referral.…”

Section: Introductionmentioning

confidence: 82%

“…It is time consuming and requires specialised equipment and a degree of training, whereas bilateral brachial BP measurements are easily taken and are in any case recommended in the assessment of new hypertensive patients. 9 In symptomatic chronic upper limb ischaemia, where the IAD is marked, 28 the predominant cause is atherosclerosis (Table 1), and this is associated with PVD. 29 It therefore seems logical that the causes of an asymptomatic IAD should be similar.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

et al. 2006

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A blood pressure (BP) difference between arms was first reported over 100 years ago. Knowledge of its prevalence and relevance to the accurate measurement of BP remains poor. Current hypertension guidelines do not emphasise it. The objectives of this study were to establish the best estimate of prevalence of the interarm difference (IAD) in the population, to consider its implications for accurate BP measurement and treatment, and to discuss its aetiology and potential as a risk marker for cardiovascular disease. Systematic literature review was carried out. The data sources were Medline EMBASE and CINAHL databases, and Index of Theses. Studies reporting prevalence rates of IAD were retrieved and considered for inclusion against explicit methodological criteria. Point prevalence rates were extracted and weighted mean prevalence rates calculated. The main outcome measures were weighted mean prevalences of systolic IADX10 and X20 mm Hg and of diastolic IADX10 mm Hg. Thirty-one studies were identified. Most had methodological weaknesses; only four met the inclusion criteria. Pooled prevalences of the IAD from these four studies were 19.6% systolic X10 mm Hg (95% CI 18.0-21.3%), 4.2% systolic X20 mm Hg (95% CI 3.4-5.1%) and 8.1% diastolic X10 mm Hg (95%CI 6.9-9.2%). In conclusion, an IAD is present in a substantial number of patients and should be looked for whenever diagnosis and treatment depend on accurate measurements of BP. The importance of an IAD should be better emphasised in current hypertension management guidelines. There is evidence associating an IAD with peripheral vascular disease, raising the possibility that its presence may predict cardiovascular events. IntroductionPatients are regularly encountered in the clinical setting with a different systolic or diastolic blood pressure (BP) in each arm. Comparisons of arm pressures have been made ever since the modern sphygmomanometer was introduced, 1 yet the significance of this finding, which Cyriax named the 'differential BP sign', 2 is still poorly appreciated today.Hypertension is one of the major causes of premature morbidity and mortality throughout the developed and developing worlds. 3 The vast majority of patients with hypertension are managed in primary care 4 and measurement of BP is the most common investigation performed in this setting. 5 The management of hypertension is known to be suboptimal; 6 therefore, knowledge of the latest guidelines, and the many factors known to influence readings, is crucial. 7 The prevalence of a systolic (sIAD) or a diastolic (dIAD) inter-arm difference, its importance for the management of hypertension, its significance as a potential marker of peripheral vascular disease (PVD) and predictor of cardiovascular disease (CVD) in hypertensive patients are the subjects of this review.Although recent ambulatory BP monitoring guidelines recommend routine bilateral assessment, 8 the latest British guidelines for the management of hypertension merely state that 'BP should initially be measured in both arms as patient...

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Section: Introductionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

et al. 2006

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“…However, given that conventional criteria used to assess causality are not satisfied, the case for a causal association between NSAIDs and poor BP control is far from proven. While it might be premature to change guideline recommendations, 14,22 which advise review of coprescribing of NSAIDs in poorly controlled hypertensive patients, it seems that the clinical importance of such an association is much less than previously suggested. If patients in primary care have inadequate control of their BP, other reasons for inadequate control, such as measurement error, 'white coat' hypertension, poor adherence to therapy and progressive disease may be more likely reasons for inadequate control (Table 5).…”

Section: Discussionmentioning

confidence: 98%

“…In relation to drug-drug interactions, NSAIDs may antagonise angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-II receptor antagonists, diuretics and beta-blockers. 8,9,12,14 There is some evidence 19 that NSAIDs do not antagonise calcium channel blockers. In sum, the weight of biological evidence appears to suggest an adverse effect of NSAIDs on BP control.…”

Section: Biological Plausibility For and Against Interaction Of Nsaidmentioning

confidence: 99%

“…This reported 9 interaction of NSAIDs on BP could have an important clinical influence 13 in poorly controlled hypertensive patients taking BP-lowering drugs. Indeed, NSAIDs are listed 3,14 as the most important 'antagonising agents' that clinicians need to consider when dealing with treated hypertensive patients who have poorly controlled BP readings. The aim of this study was to assess the impact on systolic BP (SBP) and diastolic BP (DBP) of coprescribing of NSAIDs in treated hypertensive patients in primary care.…”

Section: Introductionmentioning

confidence: 99%

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NSAID use and BP in treated hypertensives: a retrospective controlled observational study

2005

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The objective of this study was to investigate the association between NSAID use and blood pressure (BP) among a sample of treated hypertensive patients. A controlled observational study was designed in UK primary care setting. Patients with diagnosed hypertension and currently being prescribed antihypertensive medication registered with four general practices, comparing patients also prescribed NSAIDs (exposed) to those not prescribed NSAIDs (unexposed). Majority of the patients were elderly. Systolic and diastolic pressure were the outcome measures. Data were collected for 184 NSAID users and 762 nonusers with a mean age of 68 years. There was no difference in either systolic (adjusted difference 1.9 mmHg, 95% CI À0.7 to 4.5, P ¼ 0.15) or diastolic (adjusted difference 1.0 mmHg, 95% CI À0.3 to 2.3, P ¼ 0.15) blood pressure. There was no evidence of any interactions according to categories of age, sex, or number of antihypertensive drugs prescribed. Among NSAID users, there was no evidence of any differences in blood pressure according to NSAID type or dose. In conclusion we found no evidence for an association between NSAID usage and BP control in known hypertensive patients receiving antihypertensive medication in primary care. The reported association between NSAID use and BP control appears much less substantial than has been previously suggested.

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Critical Issues in Peripheral Arterial Disease Detection and Management<subtitle>A Call to Action</subtitle>

et al. 2003

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Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV

Cited by 1,036 publications

References 323 publications

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review

NSAID use and BP in treated hypertensives: a retrospective controlled observational study

Critical Issues in Peripheral Arterial Disease Detection and Management<subtitle>A Call to Action</subtitle>

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