Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease
Kranenburg, Guido; Spiering, Wilko; de Jong, Pim A.; Kappelle, L. Jaap; de Borst, Gert Jan; Cramer, Maarten J.; Visseren, Frank L.J.; Aboyans, Victor; Westerink, Jan; On behalf of the SMART Study Group
(2017) International Journal of Cardiology, volume 244, pp. 271 - 276
(Article)
Abstract
Background Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease. Methods In a cohort
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of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥ 15 mm Hg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality. Results In all patients the median inter-arm SBPD was 7 mm Hg (IQR 3–11) and 1182 (16%) patients had inter-arm SBPD ≥ 15 mm Hg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥ 15 mm Hg). Each 5 mm Hg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00–1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93–1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93–1.19). Conclusions Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease.
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Keywords: Adult, Aged, Arm/blood supply, Blood Pressure/physiology, Blood Pressure Determination/standards, Cardiovascular Diseases/diagnosis, Carotid Intima-Media Thickness/standards, Cohort Studies, Female, Follow-Up Studies, Forecasting, Humans, Male, Middle Aged, Mortality/trends, Prospective Studies, Risk Factors, Inter-arm measurements, Subclavian stenosis, Vascular disease, Systolic blood pressure differences SBPD, Atherosclerosis, Cardiology and Cardiovascular Medicine, Journal Article, Comparative Study
ISSN: 0167-5273
Publisher: Elsevier Ireland Ltd
Note: Publisher Copyright: © 2017 Elsevier B.V. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
(Peer reviewed)