Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease

Tokitsu, Takanori; Yamamoto, Eiichiro; Hirata, Yoshihiro; Fujisue, Koichiro; Sugamura, Koichi; Makino, Hírofumi; Tsujita, Kenichi; Kaikita, Koichi; Hokimoto, Seiji; Sugiyama, Seigo; Ogawa, Hisao

doi:10.1097/hjh.0000000000000616

Cited by 29 publications

(41 citation statements)

References 41 publications

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“…The median IASBPD of 4.5 mmHg obtained in the present study was somewhat greater than that reported in other studies . This might be due, at least in part, to the advanced age of the participants in the present study.…”

Section: Discussioncontrasting

confidence: 83%

“…Differences in blood pressure values between the right and left arms are usually minimal in healthy individuals, but an increase in interarm systolic blood pressure difference (IASBPD) is not uncommon in a clinical setting . Recent studies have highlighted the significant association between IASBPD and risk factors of atherosclerosis . Several studies and a meta‐analysis mostly involving individuals with increased cardiovascular risk reported significant independent associations of IASBPD ≥10 mmHg with increased cardiovascular morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Recent studies have highlighted the significant association between IASBPD and risk factors of atherosclerosis. 8,9 Several studies and a meta-analysis mostly involving individuals with increased cardiovascular risk reported significant independent associations of IASBPD ≥10 mmHg with increased cardiovascular morbidity and mortality. [10][11][12][13][14][15] Increased IASBPD is an excellent predictor of future cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

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Association of physical activity with a systolic blood pressure difference between arms in older people

Sato

Sugiura

Ohte

et al. 2017

Geriatrics Gerontology Int

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Aim: A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. Methods:Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD.Results: The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD.

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Section: Discussioncontrasting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of physical activity with a systolic blood pressure difference between arms in older people

Sato

Sugiura

Ohte

et al. 2017

Geriatrics Gerontology Int

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“…This view is supported by some published work (Olmedillas et al, 2010) and it has been suggested that larger circumference arms may be associated with higher measured SBP (Loenneke et al, 2016). Furthermore, because of the widely reported potential significance of inter-arm SBP differences as a predictor of cardiovascular morbidity (Cao et al, 2015;Tokitsu et al, 2015;Zhou et al, 2016;Kranenburg et al, 2017;Hirono et al, 2018) it was believed that the issue concerning the role that handedness might play in such inter-arm pressure differences was of significance and should be specifically addressed. A third motivating factor was that most prior assessments of inter-arm pressure differences focused on either older persons or those with already present cardiovascular symptoms.…”

Section: Discussionmentioning

confidence: 99%

Inter‐arm systolic blood pressure dependence on hand dominance

Mayrovitz

2018

Clin Physio Funct Imaging

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Inter-arm systolic blood pressure differences (SBP-DIFF) ≥ 10 mmHg have been reported useful to predict future cardiovascular-related morbidities. Although well studied in patients, there is little information on healthy young adults and the role of hand-dominance as a factor affecting SBP-DIFF. As dominant arms (DOM) tend to have greater girth and muscle development than nondominant arms (NDOM) it was reasoned that cuff pressures needed to obtain SBP may be greater on DOM causing DOM SBP to be greater. To test this hypothesis and also provide typical values, SBP was measured in left and right-handers (29·4 ± 10·4 years) in whom handedness was clearly defined. Handedness was determined by a multi-question form in 90 young adults (45 male) and SBP-DIFF determined via simultaneous measurements done in triplicate on seated subjects. The percentage of left-handers in male and female sub-groups were equal at 37·8%. Results show that the absolute SBP-DIFF in left-handers (mean ± SD) was 4·4 ± 3·8 mmHg and for right-handers was 5·0 ± 4·2 mmHg (P = 0·362). There was also no statistically significant difference among 1st, 2nd and 3rd measured SBP-DIFF for either right or left-handers or differences between right and left-handers. Results show no evidence of a higher SBP in DOM and thus clarifies the hand-dominance issue as a factor not generally needing to be considered in clinical assessments. A potentially useful secondary outcome was the finding that 14·8% of this group had at least one measured SBP-DIFF ≥ 10 mmHg a fact that may have future relevance.

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“…[8] However, a meta-analysis on the prevalence of IAD has shown a very variable proportion of subjects (1.4-38%) with IAD more than 10 mmHg. [7,[23][24][25][26][27] Various pathological causes have been considered as leading to an increase in interarm BP differences such as atherosclerosis, vasculitis, fibromuscular hyperplasia, connective tissue, and thoracic outlet compression. [10][11][12][13][14][15] In the absence of anatomic obstruction, interarm differences in SBP were thought to be related to some intrinsic property of the cardiovascular system.…”

Section: Discussionmentioning

confidence: 99%

Interarm blood pressure difference: Magnitude and prevalence in healthy adults

Inassi¹,

Razeena²,

Jowhara³

2017

Natl J Physiol Pharm Pharmacol

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Background: Hypertension is one of the major preventable causes of premature morbidity and mortality worldwide. Measurement of blood pressure (BP) is the most common investigation performed in primary care setting to manage the vast majority of hypertensive patients. BP measurement guidelines recommend that BP should be assessed in both arms at the initial visit to prevent misdiagnosis of hypertension. The interarm difference (IAD) in BP has received increasing attention in recent years because a difference of >10 mm of Hg has been found to be a potential marker of peripheral vascular disease and predictor of cardiovascular disease. Aim and Objectives: This study was conducted to determine the prevalence and magnitude of IAD in healthy adults. Materials and Methods: A total of 200 normal healthy adults were recruited for the study. BP was assessed by automatic blood pressure monitor after 5 min rest. Results: In this study, prevalences of the IAD were found to be 19.0% for systolic > or =10 mmHg, 4.5% for systolic > or =20 mmHg, and 6.0% for diastolic >or =10 mmHg. Conclusion: IAD exists in a substantial number of healthy adults. A difference of >10 mm of Hg systolic or diastolic BP should be investigated further as it is found to have a prognostic value for predicting cardiovascular events. Hence, we conclude that IAD is a simple, noninvasive and sensitive method of detecting individuals prone for cardiovascular morbidities.

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Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease

Abstract: IADs were increased in CAD patients and correlated with its severity. Greater than 10 mmHg of IAD was independently associated with future cardiovascular events. Assessing IAD by ABI measurement may facilitate risk stratification in CAD patients.

Cited by 29 publications

References 41 publications

Association of physical activity with a systolic blood pressure difference between arms in older people

Association of physical activity with a systolic blood pressure difference between arms in older people

Inter‐arm systolic blood pressure dependence on hand dominance

Interarm blood pressure difference: Magnitude and prevalence in healthy adults

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