Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Blood Pressure Measurement as a Hint About Vascular Disease
Doctors frequently speak about a patient’s “vital signs.” These are heart rate (pulse), blood pressure, and respiratory (breathing rate). Blood pressure in most patients is taken using a blood pressure cuff, commonly placed on the arm, but sometimes on a leg. Astute clinicians take the blood pressure from both arms, because a difference between the arms may signify a problem, such as a tear in the aorta, commonly called an aortic dissection. Laypersons are commonly instructed how to take a blood pressure using a cuff, either manually or with an automated blood pressure cuff device.
In an article in The Lancet entitled “Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis,” Dr. Christopher Clark and colleagues put forth the notion that differences in systolic blood pressure (the pressure signifying the moment of contraction of the heart; diastolic blood pressure signifies the moment of relaxation of the heart) of 15 mm Hg (millimeters of mercury) or more between arms could be a useful indicator of risk of vascular disease and death. While not confirmatory for this increased risk, it would logically prompt referral to a physician for further evaluation, looking for significant vascular disease.
This is not an esoteric point mentioned solely for the sake of practitioners. As more and more people measure their own blood pressures with accurate techniques and devices, then they should know information like this, so that they may screen themselves for significant diseases with the same intensity as would their healthcare provider.
On the trail or during an expedition, a finding such as this should prompt close observation of the patient for any signs or symptoms suggestive of a worsening vascular situation, and expeditious referral to a physician upon return home.
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