Assessment of Inter-Arm Blood Pressure Difference and its Associated Factors among Hypertensive Patients at Jimma Medical Center, Jimma, Southwest Ethiopia: A Comparative Cross-sectional Study

Abstract

Background: Measuring blood pressure (BP) is a simple procedure to screen individuals with elevated BP. However, the concept of measuring BP in both arms to detect an inter-arm BP difference, which prevents misdiagnosis of hypertension and may predict future cardiovascular disease risk has not gained attention. In addition, guidelines advise measuring BP in both arms during hypertension screening but it is widely ignored in practice. Objectives: This study aimed to assess inter-arm blood pressure difference and its associated factors among hypertensive patients at Jimma Medical Center, Jimma, Southwest Ethiopia, 2021. Methods: A comparative cross-sectional study design was utilized. A total of 101 hypertensive & 101 nonhypertensive respondents were selected using systematic random and purposive sampling techniques respectively. Data were collected using a semi-structured questionnaire, physical measurement, and laboratory investigation. Data were entered into epi data version 4.6.0.5 & exported to SPSS version 26 for analysis. Chi-square test, independent t-test, Pearson correlation, and Binary logistic regression were used for analysis. P-value <0.05 was considered significant for statistical analyses. Result: The prevalence of systolic inter-arm BP difference (SIABPD) in the hypertensive group was 32.7% and in healthy controls, it was 19.8%, whereas diastolic inter-arm BP difference (DIABPD) was 17.8% and 7.9% among hypertensive and non-hypertensive participants, respectively. Factors independently associated with systolic IABPD were DM with an AOR of 4.12, SBP with an AOR of 1.042 [AOR = 1.042; 95% CI: 1.012, 1.073), p = 0.005], BMI of 25-29.9 kg/m2, and ≥30 kg/m2 with AORs of 5.84 [AOR = 5.842; 95% CI: 1.206, 28.292, p = 0.028] and 7.55 [AOR = 7.546; 95% CI: 1.533, 37.140, p = 0.013] respectively, and ABI (ankle-brachial index) ≤ 0.9 with an AOR of 4.23 [AOR = 4.233; 95% CI: 1.309,13.689, p = 0.016] among hypertensive patients. In addition, DM with AOR of 5.13 [AOR= 5.127, 95% CI (1.467, 17.916), p=0.010], waist circumference with AOR of 4.01 [AOR=4.008, 95% CI (1.120, 14.337), p=0.033], DBP with AOR of 1.028 [AOR=1.028, 95% CI 1.001, 1.056, P=0.043], and total cholesterol with AOR of 1.011 [AOR=1.011, 95% CI 1.001, 1.020, P=0.033] were independent predictors of DIABPD in hypertensive patients. Conclusion: This study discovered that hypertensive patients had a significantly higher prevalence of interarm BP difference than non-hypertensive controls. The independent predictors of systolic inter-arm BP difference in hypertensive patients were BMI, DM, SBP, and ABI (ankle-brachial index) whereas DM, waist circumference, DBP, and total cholesterol were independent predictors of diastolic IABPD in hypertensive patients. Framingham risk score (FRS) was significantly correlated with systolic IABPD. Therefore, systolic IABPD may predict future CVD risk. Measurement of BP in both arms should be part of routine clinical practices in health care systems.