Correlating the relationship between interarm systolic blood pressure and cardiovascular disease risk factors

Abstract

Interarm systolic blood pressure difference (IASBPD) can predict cardiovascular disease. To investigate the relationship between IASBPD and cardiovascular disease risk factors, a total of 1426 individuals were studied. Blood pressure was assessed simultaneously and IASBPD was expressed as the absolute difference value (|R−L|).Cardiovascular disease risk factors were compared between the high IASBPD group (IASBPD ≥10 mm Hg) and the normal IASBPD group (IASBPD <10 mm Hg). An increased prevalence of hypertension, body mass index, and systolic and diastolic blood pressure were observed in the high IASBPD group (P<.05), associated with the enhanced mean values of intima-media thickness and maximum intima-media thickness (P<.05). Brachial-ankle pulse wave velocity was increased, while ankle-brachial index was lower in the high IASBPD group (P<.05). Multivariate logistic regression analysis revealed that IASBPD ≥10 mm Hg was positively associated with body mass index (odds ratio, 1.077; P=.002) and systolic blood pressure (odds ratio, 1.032; P<.001), and negatively associated with ankle-brachial index (odds ratio, 0.038; P<.001). | INTRODUCTIONThe lower ankle-brachial index (ABI) is associated with the incidence of cardiovascular disease (CVD) and peripheral artery disease (PAD).The question is raised "what does the systolic blood pressure (SBP) difference between the two arms indicate?" It has been reported that interarm SBP difference (IASBPD) is associated with peripheral vascular disease, which has been considered a predictor of CVD.1 A previous study demonstrated that CVD can be predicted when IASBPD is ≥10 mm Hg. 2 However, the association between IASBPD and cardiovascular morbidity and mortality remains elusive.Current hypertension guidelines suggest that blood pressure (BP) assessment in both arms should be used as an initial evaluation parameter of hypertension. An interarm BP difference of <10 mm Hg can be considered a normal condition, whereas the difference of ≥20/10 mm Hg demands further attention and investigation. 3 The BP difference between arms was first reported more than 100 years ago, but its clinical significance was not recognized until recently. A meta-analysis showed that the prevalence of IASBPD ≥10 mm Hg was 19.6%, 4 indicating that this is not a small probability event and PAD is also not the unique reason for IASBPD. Knowledge of the interarm BP difference remains limited, which could be important for accurate BP measurement and treatment decisions, and may be a potential risk marker for CVD. Although a questionnaire survey revealed that a consensus has been reached among 77% of physicians that BP should be measured in both arms, only 30% of respondents agreed with this recommendation, while over half disagreed, and a mere 13% adhered to it. 5 These studies show that most of the clinicians ignored the importance of measurement of BP in both arms because they did not realize the clinical significance.Carotid intima-media thickness (IMT) and plaque formation are associated with CVD, 6 as we...

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

“… 10 Cross-sectional studies report higher prevalence of systolic IAD in the presence of diabetes and cardiovascular, cerebrovascular, or peripheral arterial diseases. 10 – 12 IAD, after adjustment for BP, is associated with increased left ventricular mass, 13 greater arterial stiffness, 13 – 15 diabetic nephropathy, 16 , 17 and retinopathy. 16 Study-level meta-analyses have observed associations of IAD with cardiovascular and all-cause mortality and with increased cardiovascular event rates.…”

Inter‐arm difference in blood pressure in patients referred to tertiary hypertension center: Prevalence, risk factors, and relevance to physicians

“…Furthermore, it is possible that high inter‐arm BP difference is a marker of an adverse vascular phenotype, as suggested from its stronger association with peripheral arterial disease (PAD) in previous studies 12 . Indeed, PAD has more recently emerged as a robust predictor of adverse cardiovascular outcomes 13 .…”

Diferencia De La Presión Arterial Interbraquial Y Su Asociación Con Enfermedades Cardiovasculares

“…De igual forma se recogieron datos como edad, sexo, antecedente de fumador, antecedente de hipertensión, antecedente de diabetes, hipercolesterolemia o de lo contrario la medición del perfil lipídico. Según el objetivo del estudio, se utilizaron otros exámenes auxiliares, tales como un ecocardiógrafo, cinta ergométrica, medición del grosor de la íntima-media carotidea 15,16 y estudios angiográficos; o el uso de puntajes o "scores" tales como el Score de Gensini o el riesgo de Framingham.…”

“…En relación a los antecedentes de los pacientes revisados se observó que pacientes con antecedente de hipertensión arterial o diabetes mellitus tuvieron una mayor prevalencia de DPAIB 1,4,15,17,20 a partir de niveles superiores a 10 mmHg13, y de igual manera la DPAIB estaba relacionada con antecedente de arteriopatía periférica 19 . Se demostró que, además de la asociación entre las comorbilidades mencionadas, sus valores diferenciales fueron más altos 15,19,20 .…”

“…Los resultados de las asociaciones de la DPAIB con eventos cardiovasculares en los diferentes estudios muestran que la estenosis de la arteria carótida ≥70% 20 , un mayor grosor de la íntima-media carotidea16, 20 y bajos índices tobillo-brazo 15,20 estarían asociados a una DPAIB ≥10 mmHg y de igual manera asociado positivamente con el IMC 15,16,20 . Según Hwang et al16 niveles elevados de triglicéridos y la existencia de una placa carotidea se relacionó, igualmente, con sospecha de enfermedad arterial coronaria (OR=2.05, p=0.001).…”