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pandora jewellery This difference could be a valuable indicator of increased cardiovascular risk. Bilateral blood pressure measurements should become a routine part of cardiovascular assessment in primary care.IntroductionA difference in blood pressure readings between arms can be observed in various general populations,1 2 healthy women during the antenatal period,3 4 and populations with an increased risk of cardiovascular disease, such as people with hypertension,5 diabetes,6 7 chronic renal disease,8 or peripheral vascular disease.9 The presence of a difference between arm measurements has been implicated in a delayed diagnosis of hypertension10 and is associated with a higher prevalence of poor control in hypertension,9 as failure to standardise measurement to the arm with the highest reading can mislead decisions about management. Current guidelines recognise the need to check blood pressure in both arms11 12 but this practice has not been followed by many clinicians,13 14 including general practitioners in the United Kingdom,15 and continues to be undertaken selectively in primary care settings.16 This poor uptake may in part result from a lack of clearly presented supporting evidence for this intervention that is relevant to primary care practitioners.17The new clinical guideline for hypertension from the National Institute for Health and clinical Excellence considers an interarm difference of less than 10 mm Hg to be normal and attributes a difference of more than 20 mm Hg to underlying vascular disease.18 An evidence review for interarm differences in blood pressure was outside the remit of this update; however, it did not consider the group with an interarm difference in systolic blood pressure of 10 20 mm Hg, despite our previous systematic review suggesting that this group represents 15% of the population with hypertension.1Our previous work has suggested that an interarm difference https://www.pandorajewellry-canada.com/ in blood pressure is an independent predictor of reduced event free survival.5 19 Others have also shown an association with increased mortality in people at higher risk of vascular disease,8 9 and the need for further studies carried out in primary care settings has been highlighted.9 We further analysed an established primary care cohort to determine to what extent the difference in survival observed at five years persists at 10 years.5MethodsThe Mid Devon Medical Practice operates three separate surgeries in a rural area pandora jewellery.

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