**4. Discussion**

In the current study, 12 participants (5 males and 7 females; 1.92% of the sample size) showed an inter arm difference ≥ 10 mmHg. A previous study has suggested that interarm BP difference was more usual among young healthy study participants, with an interarm blood pressure difference > 10 mm Hg reported in 111 (12.6%) and 77 (8.8%) participants for SBP and DBP respectively [23]. The current study did not find similar results due to a low prevalence found. Another study conducted among hypertensive patients reported a prevalence of 7.7% (285 patients with a systolic interarm difference of ≥10 mm Hg), while 1.5% (57 patients) had a ≥ 10 mmHg diastolic interarm blood pressure difference. Furthermore, a study by Kim et al. [22] reported a 0.6% (21 patients) prevalence for both systolic and diastolic interarm difference ≥ 10 mmHg.

The different findings found between the current and other related studies could be because of the varying age groups, diseases profile of the participants (some being healthy and others suffering from hypertension and other chronic diseases) or even the different methods used to measure the interarm BP difference. The difference in systolic blood pressure between arms is considered a risk marker and advantageous due to that it is easy to measure clinically without additional equipment and is more acceptable to patients. Furthermore, studies have associated a systolic inter arm difference ≥ 15 mmHg [24], and ≥ 10 mmHg with cardiovascular risk and mortality [7]. The inability to detect the interarm BP difference may result in insufficient treatment of people suffering from hypertension and interrupt hypertension diagnosis. Hence, it is vital to measure blood pressure in both arms.

A previous study has reported that blood pressure measured in only one arm would lead to approximately 30% misdiagnosis of hypertensive patients being wrongfully classified as normotensive [25].

In multivariate logistic regression of the current study, a positive significant association was found between systolic interarm blood pressure and hypertension as well as gender. In addition there was also a positive significant association found between SBP and diastolic interarm blood pressure difference in the current study. A previous study by Kimura et al. [26], reported a positive association between systolic interarm systolic blood pressure > 10 mm Hg and SBP and BMI. This was different from the findings of the current study since we found a non-significant association between BMI and both IASBPD and IADBPD. Furthermore, another study by Grossman et al. [27], reported that interarm BP difference was not associated with age, BMI, and heart rate, but was in association with SBP in both young and healthy patients [27]. The latter findings are similar to the current study since we found an association between SBP and IADBPD. Moreover, A study by Grossman et al. [27] which is supported by another study by Ma et al. [28], reported that high inter arm systolic blood pressure difference seems to be more common in older than in younger people.

The study had several limitations. The study had limited variables to broadly represent the large spectrum of cardiovascular risk/health. The effect of controlling interarm blood pressure difference on cardiovascular risk could not be evaluated at this stage. The study did not have a large range in terms of the age hence the effect of age on the inter arm blood pressure difference could not be adequately determined. The cardiovascular health status of the participants was determined on a cross sectional basis hence some factors that can temporarily affect measurements may have affected the readings. The nature of the study cannot fully establish a cause and effect relationship, hence possible bias cannot be ruled out.
