The correlation between interarm blood pressure differences and postoperative complications after peripheral vascular surgery: a prospective observational study
Streszczenie
Background: A large difference in blood pressure between both arms is common in patients with disseminated atherosclerosis undergoing vascular surgery. In patients with high cardiovascular risk, inter-arm blood pressure difference > 10 mm Hg can occur in more than 38% of the population, but the impact on short-term postoperative complications is still unclear.
Material and methods: The aim of this study was to evaluate the effect of inter-arm blood pressure asymmetry on the overall postoperative complications in the Revised Cardiac Risk Index class I–II patients undergoing peripheral vascular surgery. Secondly, other possible risk factors for postoperative complications and duration of hospital stay were established. Design: Prospective observational study. Setting: Single-centre study. Patients: Ninety-five RCRI class I-II patients undergoing peripheral vascular surgery. Interventions: The authors measured blood pressure in brachial arteries on both arms in the operating room prior to administering anaesthesia for every patient enrolled in the study. After the surgery, all participants were followed up from the time of hospitalization for any postoperative complications. Main outcome measures: Blood pressure values
Results: There was no correlation found between overall postoperative complications and blood pressure differences (neither systolic, diastolic nor mean) between the arms. Patients who underwent emergent surgery had highly increased risk of postoperative complications (OR 13.0; 95% CI 1.4 to 69.3; p < 0.01) and prolonged hospital stay time (HR 2.5; 95% CI 1.7 to 3.7; p < 0.01).
Conclusion: Although the authors did not find any relevant correlation between inter-arm blood pressure differences and postoperative complications, the measurement in both arms is crucial to determine adequate baseline values prior to surgery.
Słowa kluczowe: blood pressurevascular surgerycomplications
Referencje
- Whelton P, Carey R, Aronow W, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology. 2018; 71(19): e127–e248.
- Clark CE, Taylor RS, Shore AC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012; 379(9819): 905–914.
- Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10): 1043–1049.
- Clark CE, Taylor RS, Shore AC, et al. The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ. 2012; 344: e1327.
- Cyriax EF. Unilateral Alterations in Blood-Pressure Caused by Unilateral Pathological Conditions: The Differential Blood-Pressure Sign. QJM. 1920; os-13(50): 148–164.
- Clark CE, Taylor RS, Butcher I, et al. Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk. Br J Gen Pract. 2016; 66(646): e297–e308.
- Belen E, Ozal E, Bayyigit A, et al. Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery. Kardiol Pol. 2016; 74(7): 674–680.
- Mazzeffi M, Flynn B, Bodian C, et al. Preoperative arterial pulse pressure has no apparent association with perioperative mortality after lower extremity arterial bypass. Anesth Analg. 2012; 114(6): 1170–1176.
- Venkatesan S, Myles PR, Manning HJ, et al. Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery. Br J Anaesth. 2017; 119(1): 65–77.
- Weksler N, Klein M, Szendro G, et al. The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery? J Clin Anesth. 2003; 15(3): 179–183.
- Wax DB, Porter SB, Lin HM, et al. Association of preanesthesia hypertension with adverse outcomes. J Cardiothorac Vasc Anesth. 2010; 24(6): 927–930.
- Monk TG, Bronsert MR, Henderson WG, et al. Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology. 2015; 123(2): 307–319.
- Weinberg I, Gona P, O'Donnell CJ, et al. The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study. Am J Med. 2014; 127(3): 209–215.
- National Institute for Health and Clinical Excellence. Hypertension: the clinical management of primary hypertension in adults, CG127. London: National Institute for Health and Clinical Excellence. 2016.
- Gaynor E, Brewer L, Mellon L, et al. Interarm blood pressure difference in a post-stroke population. J Am Soc Hypertens. 2017; 11(9): 565–572.e5.
- Clark CE, Taylor RS, Shore AC, et al. Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis. Br J Gen Pract. 2016; 66(652): e838–e847.
- Schwartz C, Koshiaris C, Clark C, et al. Does the right arm know what the left arm is doing? Ethnic variations in clinical interarm difference and relationship to white coat effects. J Hypertens. 2015; 33: e7.
- Verberk WJ, Kessels AGH, Thien T. Blood pressure measurement method and inter-arm differences: a meta-analysis. Am J Hypertens. 2011; 24(11): 1201–1208.
