Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

Associations between systolic interarm differences in blood pressure and cardiovascular disease outcomes and mortality

Clark, Christopher E., Warren, Fiona C., Boddy, Kate, McDonagh, Sinead T.J., Moore, Sarah F., Goddard, John, Reed, Nigel, Turner, Malcolm, Alzamora, Maria Teresa, Ramos Blanes, Rafel, Chuang, Shao-Yuan, Criqui, Michael, Dahl, Marie, Engström, Gunnar, Erbel, Raimund, Espeland, Mark, Ferrucci, Luigi, Guerchet, Maëlenn, Hattersley, Andrew, Lahoz, Carlos, McClelland, Robyn L., McDermott, Mary M., Price, Jackie, Stoffers, Henri E., Wang, Ji-Guang, Westerink, Jan, White, James, Cloutier, Lyne, Taylor, Rod S., Shore, Angela C., McManus, Richard J., Aboyans, Victor and Campbell, John L. 2020. Associations between systolic interarm differences in blood pressure and cardiovascular disease outcomes and mortality. Hypertension 10.1161/HYPERTENSIONAHA.120.15997

[img] PDF - Published Version
Download (592kB)

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.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
Centre for Trials Research (CNTRR)
Additional Information: Attribution 4.0 International (CC BY 4.0)
Publisher: American Heart Association
ISSN: 0194-911X
Funders: NIHR
Date of First Compliant Deposit: 4 January 2021
Date of Acceptance: 10 November 2020
Last Modified: 03 Feb 2021 16:16
URI: http://orca.cf.ac.uk/id/eprint/137238

Actions (repository staff only)

Edit Item Edit Item

Downloads

Downloads per month over past year

View more statistics