Association of an inter-arm systolic blood pressure difference with all-cause and cardiovascular mortality: A meta-analysis of cohort studies.

Abstract

This meta-analysis evaluated the potential association of a simultaneously measured inter-arm systolic blood pressure difference (IASBPD) and all-cause mortality and cardiovascular mortality. The Medline, Cochrane Library, Embase, and PubMed databases were searched through to April 14, 2023 for relevant literature. The outcomes were the associations of IASBPD with all-cause and cardiovascular mortality. Finally, 10 cohort studies that included 15320 individuals were included. An IASBPD of ≥15mm Hg was associated with increased all-cause mortality (pooled hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.02-1.61) but an IASBPD of ≥10mm Hg was not (pooled HR 1.28, 95% CI 0.89-1.85). The pooled HR for cardiovascular mortality was 1.88 (95% CI 1.31-2.71) for an IASBPD of ≥10mm Hg and 1.93 (95% CI 1.24-2.99) for an IASBPD of ≥15mm Hg. Subgroup analysis showed that younger patients (HR 9.03, 95% CI 2.00-40.82, p=.004) with an IASBPD ≥15mm Hg were at higher risk of cardiovascular mortality than older patients (HR 1.67, 95% CI 1.06-2.64, p=.03); the difference between groups was statistically significant (p=.04). In conclusions, our findings show that a simultaneously measured IASBPD ≥15mm Hg predicts increased all-cause mortality and an IASBPD of ≥15mm Hg or ≥10mm Hg predicts increased cardiovascular mortality. An IASBPD ≥15mm Hg appears to be more correlated with cardiovascular mortality in younger patients than in older patients.