The difference in a person's systolic and diastolic blood pressure between their arms is known as an inter-arm blood pressure difference (IAD) (1). In diverse general populations, healthy pregnant women, and persons at a higher risk of cardiovascular disease (CVD), such as those with hypertension, diabetes mellitus, chronic kidney disease, or peripheral vascular disease, a disparity in blood pressure readings between the arms can be seen (2). Systolic inter-arm differences (SIADs) in blood pressure have been linked to an increased risk of cardiovascular events, including mortality, in a large cohort of individuals without a history of vascular illness (3).
The cause of an inter-arm difference is unclear; it was initially thought to be subclavian stenosis on the side of the lower reading arm, but there is currently scant evidence to support this association in the absence of significant (i.e., 35 mmHg) systolic blood pressure differences between the arms (2). Inter-arm blood pressure difference is well-established to be linked to a combination of cardiovascular disease and risk factors. Globally, IASBPD greater than or equal to 10 mmHg is found to be present in 19.6% of the population (4).
In Africa, a study conducted in Benin by Gwladys et al with a cross-sectional study design reported that SIABPD ≥ 10mmHg was 19% (5). But there has been no previously conducted and published research in Ethiopia that revealed the magnitude of the inter-arm blood pressure difference among normotensive adults, particularly in the study setting in Ginchi town.
According to studies conducted in the Netherlands and Iran by Kranenburg et al. and Goldstein et al., respectively, inter-arm SBPD (15 mmHg) was associated with older age, higher systolic blood pressure, diabetes mellitus, hypertension, peripheral arterial disease, carotid artery stenosis, and higher carotid intima-media thickness, as well as a lower ankle-brachial index (6, 7).
Studies in the United States of America, Italy, and India by Goldstein et al., Omboni et al., and Kurian et al., respectively, revealed that a significant risk factor for the inter-arm blood pressure difference is a family history of hypertension, which is independent of other factors like age and weight. Offspring of hypertensive parents typically have a greater blood pressure than children of normotensive parents, though their BP levels are frequently considerably below the hypertensive range (7–9).
Additionally, a study in China by Ma et al. found that the blood pressure difference between the arms is favorably correlated with body mass index (10). According to a study conducted in India by Methre et al., height and weight were directly correlated with both systolic and diastolic blood pressures (SBP and DBP) (1). Further research conducted in Korea by Song et al. found that MABP had positive relationships with systolic IAD and diastolic IAD (DIAD) in blood pressure in both males and females (11).
If individuals were not screened for blood pressure in both arms, it may result in missed inter-arm differences. Raised IAD is associated with hypertension (12). Hypertension is a risk factor for coronary heart disease and the single most important risk factor for stroke (13). It has been identified as the leading risk factor for morbidity and mortality worldwide (14). If left undiagnosed and untreated, it can lead to economic loss, psychological issues (such as low self-esteem, depression, and anxiety), decreased job productivity, and a worse quality of life for both men and women who suffer from it, with serious ramifications for families and society as a whole (15). Because of its great incidence and ability to predict cardiovascular illness, clinical guidelines (16, 17) recommend measuring blood pressure in both arms. Even though 77% of doctors were aware that blood pressure in both upper limbs should be checked during initial hypertension examinations, only 30% agreed with the recommendation, and only 13% followed it (16).
In addition, there is currently no clinical guideline that recommends measuring anthropometric parameters, routinely in conjunction with arterial blood pressure. Through early detection, simple lifestyle modifications, and the help of modern medical treatment, the effect of the inter-arm blood pressure difference can be largely controlled, and individuals with a raised inter-arm blood pressure difference can lead a prolonged and healthy life.
To my knowledge there is no research done in Ethiopia on the proposed study. Also, most of the previous studies conducted globally were among unhealthy adults and facility based, except for a few. Further, previous studies had not addressed the association between the inter-arm blood pressure difference with pulse rate and mid-upper arm circumference. Therefore, this study was aim to determine an association of anthropometric parameters and family history of hypertension with the inter-arm blood pressure difference and it provides key information for study participants about their blood pressure status, and inter-arm blood pressure difference. This helps to create awareness among them so that they can be screened early and take preventive measures against its consequences.
The study findings may encourage and direct health professionals to implement routine and both arm blood pressure measurements, as well as assess the family history of hypertension, and anthropometric parameters, among individuals visiting health facilities during their visit, which may meet the needs of the clients.
For higher institutions, this study may provide them with insights into the progress of the problem situation regarding the public health importance of inter-arm blood pressure difference and discourse in understanding its severity, which may give them the idea to conduct training or seminars that will equip health professionals with new motivation in assessing inter-arm blood pressure difference and correlated factors among healthy adults.
For policymakers/planners, this study might be helpful as an input for future planning to decide whether routine both arm blood pressure measurement evaluation should be indicated for specific circumstances or generally in normotensive adults. Also, for future researchers, the result of this research will be an input for further studies and can be used as related literature.