Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality

Abstract

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.02–1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01–1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00–1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01–1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06–1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227

Inter-arm blood pressure difference and cardiovascular risk estimation in primary care: a pilot study

“…The results of this pilot study do, however, illustrate the practical application of our published risk tables (available at: https://medicine.exeter.ac.uk/research/healthresearch/primarycare/interpressipd/riskadjustmenttables/) in a primary care setting, indicating the potential use of IAD to refine cardiovascular risk assessment. 19 The hazard ratios applied to IAD are derived from our separate INTERPRESS-IPD Collaboration; the largest international dataset assembled to examine the implications of an IAD for prediction of mortality and cardiovascular mortality. 19 This study used the Microlife Watch BP Office device -a two cuff device capable of repeated simultaneous measures with good reproducibility.…”

“…19 The hazard ratios applied to IAD are derived from our separate INTERPRESS-IPD Collaboration; the largest international dataset assembled to examine the implications of an IAD for prediction of mortality and cardiovascular mortality. 19 This study used the Microlife Watch BP Office device -a two cuff device capable of repeated simultaneous measures with good reproducibility. 26 Our INTERPRESS-IPD Collaboration data are derived largely from sequential BP measurements, which generally yield a greater magnitude in IAD than comparable simultaneous measurements.…”

“…We also confirmed and quantified the association of IAD with elevated risk after adjustment for ASCVD, Framingham or QRISK2 risk scores, providing data that can be directly applied to a primary care population. 19 The Department of Health (DoH) introduced the National Health Service (NHS) Health Check Programme in 2009; it invites individuals aged 40 to 74 years, who are free of cardiovascular disease, to attend a cardiovascular assessment session, usually in primary care practices, every five years. 20 This session includes BP measurements and other risk marker assessments, thus offering the opportunity to measure BP in both arms to identify IAD in people without a vascular disease diagnosis.…”

“…It also confirmed and quantified the association of IAD with elevated risk after adjustment for ASCVD, Framingham, or QRISK2 risk scores, providing data that can be directly applied to a primary care population. 19 …”

Diferencia de presión arterial entre brazos: concordancia entre 2 métodos automáticos de medición simultánea y reproducibilidad entre visitas

“…En los últimos años se ha producido un interés creciente en la diferencia de presión arterial entre ambos brazos (dPEB) al relacionarse una dPEB sistólica aumentada (≥ 10 mmHg) con la arteriopatía periférica 1 , 2 , 3 , 4 , 5 , la presencia de enfermedad cardiovascular 6 , 7 , 8 , 9 , riesgo cardiovascular elevado 4 , 6 , 10 , 11 , 12 , 13 y una mayor mortalidad 5 , 8 , 10 , 12 , 14 , 15 , 16 .…”