Journal of Cardiology & Current Research Inter-Arm Blood Pressure Difference and Resistant Hypertension Volume 2 Issue 2 - 2015 Hisham Ben Lamin*, Edwin Tulloch Reid, Ernest Madu, Chiranjivi and Hikmet Subhi Clinical Cardiologist, Heart Institute of the Caribbean, Spain *Corresponding author: Hisham A Ben Lamin, Clinical Cardiologist, Heart Institute of the Caribbean, Calle Ribera 9, Priego de Cordoba 14800, Cordoba, Spain, Tel: + 34 626 701494; Email: Received: January 20, 2015 | Published: March 06, 2015 Research Article Introduction The background of our research was based on the high prevalence of uncontrolled hypertension in the form of true resistant hypertension in the studied community and how to relate it to the inter-arm blood pressure difference and the latter could be a clue to extract those patients for further management away from other hypertensive patients (without resistance to medications). This study was interesting to us especially no previous attempt was done to reveal this association. Methods In This study, 82 consecutive subjects were volunteered from the hypertension clinic at heart institute of the Caribbean- Jamaica. None of the subjects had arrhythmia or chronic renal disease (defined as: serum Creatinine level>2.2 mg/ dL [>194μmol/L]) [1] and all of them were taking their medications regularly during the study period. The following demographic variables were assessed at the initial visit: age, sex, handedness, race/ethnicity, body mass index, and history of cardiovascular disease. Arm circumference was measured, and the appropriate cuff size was selected. The patients sat quietly with their backs supported without crossing their legs and with both arms supported at heart level for 5 minutes. The measurements were done first time by well trained nurses and repeated the second time by the attending physicians and at the third time by the nurses again. The three measurements were compared for accuracy. The instruments used are the regular mercury Sphygmo-manometers after checking their accuracy and performance and the model was-Baumanometer W A Baum Co. INC. Copiague, NY, USA. Data from 55 patients who had uncontrolled BP and on multiple medications were analyzed separately from those of the remaining 27 patients. Patients with Same arm BP difference were excluded from the study. The definition of resistant hypertension that was applied to the selected patients is (The failure to reach goal blood pressure in patients who are adhering to full doses of an appropriate 3 drug (or more)-regimen that includes a diuretic) [2,3]. The goal was to reach with blood pressure < 140/90 mmHg and according to this definition and criteria we selected our patients from the hypertensive clinic. Results About 90% of the patients were right handed [n=71.1], 60% were diabetics [n= 47.4] and 20% had stable angina [n=15.8]. Total of 100% of patients were on the regular anti- hypertensive medications. Comparison analysis was done between these 2 groups and seen in (Table 1&2). Large inter- arm systolic BP differences were consistently seen in 54 patients with uncontrolled hypertension and on at least 3 medications for hypertension one of them was a diuretic. In the remaining patients [2], the systolic BP and the diastolic BP, respectively, were either equal or slightly higher between both arms by less than 5-10 mmHg and they were on one or two medications for hypertension. The large inter-arm BP difference was consistent mainly in individuals with uncontrolled BP and on multiple medications (at least 3 medications and one of them is a Diuretic) which we consider as a resistant hypertension group of patients [2,3] and prompt aggressive medical management should be taken to avoid series of complications that may take place and may establish an end organ damage with poor prognosis [4-6]. The patients were followed for 6 months and were given the optimum anti-hypertensive medications including the HCTZ diuretic. The improvement was slow and the difference in BP measurements between the arms was persistently wide giving us a strong clue to the presence of a resistant stage that we should seriously consider. In contrary, the group 2 individuals with a non significant difference in both arms BP, showed good compliance to medications during the same period of 6 months and same risk factors control. It was interesting that the female group was more resistant than the male group in this study, although we have done the same control on risk factors, including avoiding the oral contraception in active females. This was expressed by persistent high measure of inter-arm BP difference of 15-20 mmHg in female [group 1, period 2]. While it was a persistent high measure of inter-arm BP difference of (10- 15 mmHg) in Male [group 1, period 2]. In the present study, we found that there is a persistent inter-arm BP difference among Submit Manuscript | http://medcraveonline.com J Cardiol Curr Res 2015, 2(2): 00055 Abstract The prevalence of hypertension is high in the Jamaican population, aggravated by the domination of the African Black origin of this community. It is also very obvious that most of the patients of hypertension are using multiple medications and most of them without true control. We tried in this study to correlate the presence of resistant hypertension and the inter-arm blood pressure difference. It is unclear to what extent inter-arm blood pressure (BP) differences are related to resistant hypertension. The present study was designed to resolve this issue especially for the True-drug induced resistant hypertension. Keywords: Hypertension; Resistant hypertension; Inter-arms blood pressure difference