Inter‐Arm Blood Pressure Differences May Be Important for Predicting Mortality

Öztürk, Cengiz; Balta, Şevket; Öztürk, Ahmet; Aparcı, Mustafa; Sadir, Serdar; Çelik, Turgay

doi:10.1111/jch.12659

Cited by 2 publications

(3 citation statements)

References 10 publications

(12 reference statements)

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“…BP changes from moment to moment in response to autonomic, humoral, mechanical, myogenic, and environmental stimuli should be noted. 2 BP measurement may be affected by several factors such as smoking, temperature, emotional stress, and environmental stimuli. In order to investigate the effects of these factors on BP levels, BPV is a good tool obtained by visit-to-visit or ambulatory monitoring.…”

Section: To the Editormentioning

confidence: 99%

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Blood Pressure Variability Provides Useful and Prognostic Information on the White‐Coat Effect Among Older Patients

Öztürk

Demır

et al. 2016

J of Clinical Hypertension

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Tanner and colleagues 1 with great interest. They aimed to determine the white-coat effect (WCE) and investigate the prevalence of white-coat hypertension (WCH) among younger and older adults. The authors concluded that clinic systolic blood pressure (SBP) was higher than outof-clinic SBP among participants 60 years and older vs those younger than 60 years and that clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white-coat effect. According to the results, the authors provide suggestions about the role of ambulatory blood pressure (BP) monitoring in guiding antihypertensive treatment, elevated clinic BP, lower out-of-clinic BP, and white-coat effect among older adults. 1Ambulatory BP monitoring not only provides information on BP level but also on the diurnal changes in BP.2-6 Both daytime and nighttime BP consistently predicted the composite endpoint of all cardiovascular events. Twenty-four-hour ambulatory BP monitoring is the best way of excluding white-coat hypertension in patients with higher BP measurements in the doctor's office. It is also known that 24-hour BP is superior to only one BP measurement in the association of target organ damage and in the prediction of future cardiovascular events and mortality, 7-9 which is currently recommended by the latest guideline of the European Society of Hypertension.10 Through 24-hour BP monitoring, BP variability (BPV) can be derived and provide significant prognostic information, independent of mean BP.BP is not a constant condition so it may be affected by mental and physical activity and sleep. BP changes from moment to moment in response to autonomic, humoral, mechanical, myogenic, and environmental stimuli should be noted.2 BP measurement may be affected by several factors such as smoking, temperature, emotional stress, and environmental stimuli. In order to investigate the effects of these factors on BP levels, BPV is a good tool obtained by visit-to-visit or ambulatory monitoring. There are some parameters needed in order to define BPV such as standard deviation (SD) of day-night and 24-hour BP, coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV) derived from ambulatory BP monitoring. 9,10 There are some reports and meta-analyses on the relationship between BPV and all-cause mortality. In a recent study, it was shown that visit-to-visit systolic BP variability, independent of age and mean systolic BP, was a predictor of cardiovascular and all-cause mortality and stroke. In an another study, the predictive value of visit-to-visit systolic BPV namely SD, CV, VIM, and ARV for cardiovascular events and all-cause mortality was shown. It was reported that a 1 mm Hg increase in SD was significantly associated with a 3% higher risk of all-cause mortality, a 10% higher risk of cardiovascular mortality, and a 2% higher risk of stroke. A 1% increase in CV was significantly associated with a 4% higher risk of all-cause mortality, a 1% higher risk of cardiovascular mortality, and a 5% higher risk ...

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Section: To the Editormentioning

confidence: 99%

“…[2][3][4][5][6] Both daytime and nighttime BP consistently predicted the composite endpoint of all cardiovascular events. Twenty-four-hour ambulatory BP monitoring is the best way of excluding white-coat hypertension in patients with higher BP measurements in the doctor's office.…”

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confidence: 99%

Blood Pressure Variability Provides Useful and Prognostic Information on the White‐Coat Effect Among Older Patients

Öztürk

Demır

et al. 2016

J of Clinical Hypertension

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“…Ankle‐brachial index (ABI) has been developed as a first‐line tool for screening lower extremity arterial disease, also called peripheral artery disease (PAD), a marker for generalized atherosclerosis and a predictor for cardiovascular and all‐cause mortalities . Inter‐arm systolic BPDs (IASBPD) has been linked to increased cardiovascular and overall mortalities by many cohort studies based on unselected populations and selected populations with diabetes, hypertension or established vascular diseases and meta‐analysis, although there is still controversy in the elderly . IASBPD is also indicated to be associated with PAD and various organ damage including coronary artery calcium score, carotid intima‐media thickness and plaque, arterial stiffness, albuminuria and left ventricular mass index/hypertrophy (LVMI/LVH) .…”

Section: Introductionmentioning

confidence: 99%

Significance of the combination of inter‐limb blood pressure differences in the elderly: The Northern Shanghai Study

et al. 2019

J of Clinical Hypertension

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Whether the combination of inter‐arm and inter‐leg systolic blood pressure differences (BPDs) and ankle‐brachial index is of clinical significance remains unclear. In this study, we aimed to investigate the association of the combination of inter‐limb systolic BPDs with cardiovascular risk factors and hypertension‐mediated organ damage (HMOD). A total of 2621 elderly subjects from the Northern Shanghai Study were divided into Group A, B, and C consisting of participants with 0, 1, and ≥2 abnormal inter‐limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular, and renal damage between groups and logistic regression models were conducted. The proportions of subjects presenting 0, 1, and ≥2 abnormal inter‐limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Upward trends, from Group A, through Group B, to Group C, were observed for the level or prevalence of nearly all cardiovascular risk factors and HMOD (P for trend ≤0.007 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (vs Group A: Odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.43‐2.48; vs Group B: OR = 1.46, 95% CI = 1.08‐1.97), arterial stiffness (vs Group A: OR = 1.26, 95% CI = 0.96‐1.65; vs Group B: OR = 1.36, 95% CI = 1.01‐1.83), and left ventricular hypertrophy (vs Group A: OR = 1.35, 95% CI = 1.04‐1.76; vs Group B: OR = 1.25, 95% CI = 0.93‐1.67), when compared with Group A and B. In conclusion, the combination of abnormal inter‐limb systolic BPDs significantly associates with greater burden of cardiovascular risk factors and higher likelihood for HMOD, especially carotid plaque, arterial stiffness, and left ventricular hypertrophy.

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Inter‐Arm Blood Pressure Differences May Be Important for Predicting Mortality

Cited by 2 publications

References 10 publications

Blood Pressure Variability Provides Useful and Prognostic Information on the White‐Coat Effect Among Older Patients

Blood Pressure Variability Provides Useful and Prognostic Information on the White‐Coat Effect Among Older Patients

Significance of the combination of inter‐limb blood pressure differences in the elderly: The Northern Shanghai Study

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