Inter-arm Blood Pressure Difference in Type 2 Diabetic Patients and Ambulatory Blood Pressure Monitoring :A Clinical Dilemma


background: Frequently coexistent condition in type 2 diabetes mellitus is hypertension and vice versa. Measurement of blood pressure by ambulatory blood pressure monitoring is superior to ordinary blood pressure . Blood pressure disparity reflects vascular diseases which diabetic patients liable for. Inconsistency in selecting the proper arm for blood pressure measurement may create a clinical dilemma in the presence of systolic and/or diastolic disparity.Aim :We tried in this study to set proper steps in choosing the suitable arm for ambulatory blood pressure monitoring cuff fitting.Material and Methods :Consecutive 140 type 2 diabetes mellitus patients aged 29 years and elder were examined by sequential ordinary blood pressure and simultaneous dual ambulatory blood pressure monitoring.Results: Systolic disparity grade I was dominant (75.7%) as well as diastolic disparity grade I (86.4%). The mean systolic and diastolic blood pressure in the dominant arm was higher than that in the non-dominant arm with significant pressure differences (<0.001).Age and duration of diabetes had positive impacts on systolic and diastolic disparities while gender and Hemoglobin A1C had no impacts. Systolic and diastolic blood pressures were significantly different in both arms when studied over day-time, night-time, and 24-hours ambulatory monitoring. Systolic and diastolic differences in the dominant arm and the non-dominant arm had been shown to have significant mean differences with the mean ambulatory day-time blood pressure.Discussion: Sequential method is an accepted modality and the arm with the higher systolic and/or diastolic blood pressure is the suitable arm for ambulatory monitoring and generally mirroring OBP