Inter-arm Difference Research Articles

Simultaneously measured interarm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients

Abstract Background/Introduction Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events, previous studies have demonstrated associations with other risk parameters. Purpose We aimed to reproduce these associations in a cohort of 199 treated, at-risk, hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage. Methods Simultaneously measured Inter-arm blood pressure differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients of a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multivariate regression models. Results Out of 199 participants, 90 showed an Inter-arm blood pressure difference of more than 5 mmHg. The Inter-arm difference was not associated with PWV. Furthermore, neither observed single blood pressure measurements nor 24 hour ambulatory blood pressure was associated with Inter-arm blood pressure differences. Conclusion In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design or the sample characteristics of this treated, hypertensive cohort may explain the negative results. The limited sample size of the study poses a challenge to the detection of smaller effects in our study. Funding Acknowledgement Type of funding sources: None.

Moderate to severe obstructive sleep apnea is independently associated with inter-arm systolic blood pressure difference: Tokyo Sleep Heart Study.

Obstructive sleep apnea (OSA) is recognized as an independent risk factor for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD), inter-ankle systolic blood pressure difference (IAND), and ankle-brachial index (ABI) are all known predictors of cardiovascular events. The aim of the present study was to investigate the association between OSA and four-limb blood pressure differences. We conducted this cross-sectional study in a large sleep cohort from Tokyo Sleep Heart Study. In 2643 consecutive patients who visited our sleep clinic for polysomnography between 2005 and 2017, all the patients underwent blood pressure measurement simultaneously in all the four limbs by oscillometric methods. The prevalence rate of IAD ≥10 mmHg was significantly higher in the moderate OSA (15 ≤ apnea-hypopnea index [AHI] < 30) group (4.2%) and severe OSA (AHI ≥ 30) group (4.6%) than that in the no/mild (AHI < 15) OSA group (1.4%). Multivariate logistic regression analysis also identified moderate to severe OSA as being significantly associated with IAD ≥10 mmHg, even after adjustments for confounding variables (moderate OSA: odds ratio [OR], 4.869; 95% confidence interval [CI], 1.080-21.956; P = 0.039; severe OSA: OR, 5.301; 95% CI, 1.226-22.924; P = 0.026). However, there were no significant associations of the OSA severity with IAND ≥15 mmHg or ABI <0.9. Moderate to severe OSA was independently associated with the IAD, not but with the IAND or ABI.

Evaluation of a novel mobile phone application for blood pressure monitoring: a proof of concept study.

To provide information about the clinical relevance of blood pressure (BP) measurement differences betweena new smartphone application (OptiBP™) and the reference method (automated oscillometric technique) using a noninvasive brachial cuff in patients admitted to the emergency department. We simultaneously recorded three BP measurements using both the reference method and the novel OptiBP™(test method), except when the inter-arm difference was > 10mmHg BP. Each OptiBP™ measurement required 1-min and the subsequent reference method values were compared to the values obtained with OptiBP™ using a Bland-Altman analysis and error grid analysis. Among the 110 patients recruited, OptiBP™ BP values could be collected on 61 patients (55%) and were included in the statistical analysis. The mean of differences (95% limits of agreement) between the reference method andthe test method were - 0.1(- 22.5 to 22.4mmHg) forsystolic arterial pressure (SAP), - 0.1(- 12.9 to 12.7mmHg) fordiastolic arterial pressure (DAP)and - 0.3(- 18.1 to 17.4mmHg) formean arterial pressure (MAP).The proportions of measurements in risk zones A-E were 86.9%, 13.1%, 0%, 0%,and0% for MAPand89.3%, 10.7%, 0%, 0%,and0% for SAP. In this pilot study conducted in stable and awake patients admitted to the emergency department, the absolute agreement between the OptiBP™ and the reference method was moderate. However, when BP measurements were made immediately after an initial calibration, error grid analysis showed that 100% of measurement differences between the OptiBP™ and reference method were categorized as no- or low-risk treatment decisions for all patients.Trial Registration: ClinicalTrials.gov Identifier: NCT04121624.

Simultaneously measured inter-arm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients.

Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events. Previous studies have demonstrated associations with other risk parameters. We aimed to reproduce these associations in a cohort of 199 treated, at-risk hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage. Simultaneously measured inter-arm blood pressure(BP) differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients from a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multi-variate regression models. Out of 199 participants, 90 showed an inter-arm BP difference of more than 5 mmHg. The inter-arm difference was not associated with PWV. Furthermore, neither observed single BP measurements nor 24 hour ambulatory BP was associated with inter-arm BP differences. In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design and the sample characteristics of this treated, hypertensive cohort may have contributed to the negative findings. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.

Effects of backhand stroke styles on bone mineral content and density in postmenopausal recreational tennis players: a cross-sectional pilot investigation

BackgroundOne-handed backhand (OB) and two-handed backhand (TB) styles are commonly used in tennis, but only TB generates loadings on the non-dominant arm and a greater extension torque on the rear leg, leading to a greater axial torque involving rotation of the hip and trunk. The current study investigated whether those effects can further affect bone area (BA), bone mineral content (BMC) and density (BMD) in postmenopausal recreational tennis players.MethodsBA, BMC and BMD of the lumbar spine, hip and distal radius were assessed using dual-energy X-ray absorptiometry in TB, OB, and swimmers’ group as a control (SG) (all participants self-reported for at least 5 years of exercise history, n = 14 per group). Muscular strength was assessed with a hand dynamometer. Among these three groups, the BA, BMC and BMD of distal radius and muscle strength were assessed using one-way ANOVA, and those of the lumbar region and the hip joint were tested by one-way ANCOVA.ResultsTB showed higher BMC and BMD for both lumbar spine and femoral neck than SG (all, p < 0.05). Both OB and TB showed greater BMD inter-trochanter than SG (both, p < 0.05). OB demonstrated greater inter-arm differences in the distal radius, which involved 1/3 distal for BMC and mid-distal radius for BMD compared to the TB and SG (all, p < 0.05). In addition, greater inter-arm asymmetry of grip strength was found in OB compared to TB and SG (both, p < 0.05).ConclusionFor postmenopausal women, performing two-handed backhand strokes, leads to higher BMC and BMD in the non-dominant arm, the lumbar region, and hips, indicating potential benefit to maintain bone health and strength. Whether this result leads to reducing the risk of osteoporosis needs to be investigated in further research.

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease.

Background Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We investigated the relationship between interarm systolic blood pressure difference and coronary artery disease. Methods We retrospectively analyzed data for patients undergoing coronary angiography and brachial-ankle pulse wave velocity examination during hospitalization from 2013 to 2018. Patients underwent simultaneous upper arm blood pressure measurement. Interarm systolic blood pressure difference (IASBPD) was defined as the absolute value of the difference between the right and left upper limb systolic blood pressure. Patients with IASBPD ≥10 mmHg constituted the high group, and those with IASBPD <10 mmHg constituted the normal group. We also recorded data for cardiovascular risk factors. Coronary artery disease was defined as ≥50% vessel stenosis or having undergone interventional therapy according to coronary angiography results. Results Compared with the normal group, the number of patients with coronary artery disease was higher in the high group (86.1% vs. 74.6%, P=0.029). Multiple logistic regression showed that IASBPD ≥10 mmHg were positively correlated with coronary artery disease (odds ratio, 2.313; 95% confidence interval, 1.086–4.509; P=0.029), and as the IASBPD value increased, the correlation also gradually increased. Conclusions IASBPD ≥10 mmHg was positively related to coronary artery disease and increased IASBPD values were correlated with coronary artery disease severity.

Murmurs other than the early diastolic murmur in aortic dissection.

The purpose of this review is to draw attention to the presence and significance of murmurs other than the murmur of aortic regurgitation, in patients with aortic dissection. For that purpose, a literature search was conducted using Pubmed and Googlescholar. The search terms were "dissecting aneurysm of the aorta", "systolic murmurs", "ejection systolic murmurs", "holosystolic" murmurs, "continuous murmurs", and "Austin-Flint" murmur. Murmurs other than the murmur of aortic regurgitation, which were associated with aortic dissection, fell into the categories of systolic murmurs, some of which were holosystolic, and continuous murmurs, the latter attributable to fistulae between the dissecting aneurysm and the left atrium, right atrium, and the pulmonary artery, respectively. Mid-diastolic murmurs were also identified, and these typically occurred in association with both the systolic and the early diastolic murmurs. Among patients with systolic murmurs clinical features which enhanced the pre-test probability of aortic dissection included back pain, stroke, paraplegia, unilateral absence of pulses, interarm differences in blood pressure, hypertension, shock, bicuspid aortic valve, aortic coarctation, Turner's syndrome, and high D-dimer levels, respectively. In the absence of the murmur of aortic regurgitation timely diagnosis of aortic dissection could be expedited by increased attention to parameters which enhance pretest probability of aortic dissection. That logic would apply even if the only murmurs which were elicited were systolic murmurs.

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Aim Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

Effect of static body and arm position on blood pressure in young healthy college students

While interarm blood pressure differences have been regularly reported in older, diseased populations, it is not entirely known whether interarm BP differences exist in young, healthy populations. It is also well established that body and arm position influence BP measurements, but it isn't fully clear whether this observation holds true for both arms. The purpose of this study was to examine whether interarm BP differences exist in different static body and arm positions in young, healthy subjects. It was hypothesized that no interarm BP differences would be observed, independent of body and arm position. Young (20.4y/o; SD=1.20), college student subjects (n=18; 9 males; 9 females) had BP taken from both arms while standing, sitting, and supine, with arm parallel and perpendicular to the body. Respiratory rate was locked at 15-20bpm for each subject, and BPs were obtained 1 minute after the change in body or arm position. Subject mean body mass index was 27.5kg/m2 (SD=5.74) and all subjects were college athletes. No within arm differences in BP were observed for the right or left arm, independent of body and arm position. The left arm tended to have higher mean systolic BP when parallel (stand 149.2mmHg, SD=22.2; sit 140.5mmHg, SD=20.8; supine 134.6mmH, SD=19.1) or perpendicular (stand 129.5mmHg, SD=20.7; sit 124.2mmHg, SD=18.0) compared to the right arm mean systolic BP when parallel (stand 125.3mmHg, SD=12.6; sit 124.6mmHg, SD=9.8; supine 121.2mmHg, SD=10.7) or perpendicular (stand 113.6mmHg, SD=13.1; sit 110.3mmHg, SD=11.2). The left arm also tended to have higher mean diastolic BP when parallel (stand 88.2mmHg, SD=14.4; sit 79.4mmHg, SD=13.4; supine 74.1mmHg, SD=10.2) or perpendicular (stand 68.1mmHg, SD=11.6; sit 64.1mmHg, SD=11.3) compared to the right arm mean diastolic BP when parallel (stand 75.6mmHg, SD=8.3; sit 74.0mmHg, SD=8.8; supine 66.8mmHg, SD=8.8) or perpendicular (stand 64.8mmHg, SD=9.6; sit 60.1mmHg, SD=9.4). However, no statistically significant interarm BP differences were observed, independent of arm or body position. Heart rate tended to decline as subjects moved from standing (86.7bpm, SD=12.8) to sitting (75.9bpm, SD=10.3) to supine (66.4bpm, SD=7.6), but this was not statistically significant. The results of this study should be taken into consideration when obtaining BPs from young, healthy people. This is particularly important given the regular reporting of interarm BP differences in older, diseased populations. Future studies should examine whether interarm BP differences exist in older, diseased populations in different body and arm positions.

SYSTOLIC INTER-ARM BLOOD PRESSURE DIFFERENCE AND COGNITIVE DECLINE: FINDINGS FROM THE INTERPRESS-IPD COLLABORATION

Objective: Hypertension and dementia are associated with older age and each other. As the populations age, prevalence of dementia will rise, representing substantial costs and care burdens for society. Currently, no interventions halt established cognitive decline, therefore approaches focus on prevention. Systolic inter-arm differences (IAD) in blood pressure (BP) and cognitive decline are associated with cardiovascular disease. We recently published initial evidence for associations of IAD with prospective cognitive decline and now present findings from the INTERPRESS-IPD Collaboration, examining associations of IAD with mild cognitive impairment (MCI) development and dementia. Design and method: Individual participant data meta-analyses. We examined time-to-event data for new diagnoses of MCI and dementia, according to IAD status in univariable and multivariable regression models, stratified by study. Multivariable analyses were adjusted for systolic BP, age, sex and highest educational attainment. We also examined changes in Mental State Examination (MSE) scores, with adjustments as above, plus follow-up duration. Results: Mean age was 66.2 years, 55% were female, 84% were of White ethnicity and mean systolic IAD was 7.0 mmHg. During 10-year follow-up, 5.9% of 4,635 individuals, from 3 cohorts, had new diagnoses of MCI. In univariable analyses, MCI was associated with systolic IAD &gt;/=5mmHg [Hazard Ratio, 1.34 (95%CI 1.04 to 1.72); p=0.022] and &gt;/= 0mmHg [1.33 (1.03 to 1.73); p = 0.032]. After adjustment, associations with systolic IADs &gt;/ = 5mmHg [1.31 (1.02 to 1.67); p = 0.036] and &gt;/=10mmHg [1.29 (0.99 to 1.68); p = 0.056] remained. There were 95 new diagnoses of dementia during follow-up; no associations were observed between dementia diagnosis and IAD. MSE scores were recorded for 2,709 participants; 15.5% showed clinically meaningful reductions (&gt;/=5 points) during follow-up. Decreases were associated with IADs &gt;/=5mmHg (p=0.004) and &gt;/=10mmHg (p = 0.006) on univariable analyses. After adjustment, associations with IADs &gt;/=5mmHg remained (p = 0.033); age and educational attainment attenuated the association with IADs &gt;/ = 10mmHg (p = 0.11). Conclusions: We present the first time-to-event analyses of MCI development with IAD and demonstrate that systolic IADs &gt;/ = 5mmHg and &gt;/ = 10mmHg are associated with MCI onset. If confirmed, these findings could inform individualised treatment decisions to minimise risk of future cognitive decline.

THE ASSOCIATION BETWEEN ARTERIAL STIFFNESS MARKERS AND THE SEVERITY OF CORONARY ARTERY DISEASE AS ASSESSED BY SYNTAX II SCORE IN HYPERTENSIVE PATIENTS WITH INSULIN RESISTANCE

Objective: The Endothelial dysfunction and the arterial stiffness are the signs of cardiovascular diseases especially in the hypertensive patients with insulin resistance. The endothelial dysfunction were assessed by the brachial flow mediated dilatation. The arterial stiffness markers which are expected to be early increased in hypertensive patients with insulin resistance were assessed for detection of coronary artery disease. The aim of this study: to detect the association between arterial stiffness markers and the presence of coronary artery disease and the assessment of CAD severity by syntax II score in hypertensive patients with insulin resistance. Design and method: A total of 120 hypertensive patients who underwent coronary angiography in catheterization unit from January 2019 to October 2020 by using the (homesostatic model assessment of insulin resistance) were divided into (Group A) sixty patients with insulin resistance and CAD (Group B) sixty patients without insulin resistance and no CAD. The brachial flow mediated dilatation was measured. The Mobil O Graph blood pressure device was used to measure the PWV and Aix at rest and three min after isometric handgrip exercise at 40% of the maximal handgrip power. The inter-arm systolic blood pressure difference from both arms was calculated. The severity of the coronary artery diseases were assessed by the syntax II risk score. Results: In our study the predictive value of FMD for the detection of CAD in group A with a cutoff value &gt;0.448 (P &lt; 0.0001), (sensitivity of 88.9% and specificity of 91.8%). After isometric exercise handgrip for 3 min, the Aix was increased significantly in patients with CAD (before 16.7% vs. 3 min after 23.6%, P = 0.001). PWV was increased significantly in patients with CAD (before 11.5 vs. 3 min after 12.2 m/s,P = 0.001). The Inter Arm Blood Pressure Difference more than 10mmHg were associated with a high syntax II risk score compared to the patients with values less than 10 mmHg (p &lt; 0.001). Conclusions: FMD and after isometric handgrip exercise (PWV and Aix), are independent predictors for CAD. The Inter Arm Blood Pressure Difference more than 10mmHg was associated with a higher syntax II risk score.

INTER-ARM BLOOD PRESSURE DIFFERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA

Objective: Obstructive sleep apnea (OSA) is an independent risk for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD) is noted as a marker for future cardiovascular events. However, underlying mechanisms of IAD has not been fully clarified. The present study was conducted to examine whether OSA is associated with IAD. Design and method: In 2645 consecutive patients aged over 30 {age: 56 ± 13 years old, mean apnea-hypopnea index (AHI): 39 ± 23 /h}, who visited sleep clinic to perform polysomnography in 2005–2017, blood pressure in both arms were measured simultaneously by oscillometric methods. The IAD was defined as absolute value of the systolic blood pressure difference in both arms. Results: In all included patients, patients with IAD over 10 mmHg were noted in 3.7%. When patients were divided into two groups: severe OSA (AHI over 30) group and mild to moderate OSA (AHI &lt; 30) group, the prevalence rate of IAD over 10 mmHg were higher in severe OSA group than those in mild to moderate group (4.6% vs 2.8%, P &lt; 0.05)(Figure). Multiple linear regression analysis demonstrated that AHI was an independent (P &lt; 0.05) determinant of IAD, even after the adjustments of age, gender, body mass index, hypertension, and another variables. Conclusions: OSA may be a risk for IAD. The plausible explanation is that pathophysiological abnormalities related with OSA, such as the negative intrathoracic pressure, may affect IAD.

Magnitude and significance of interarm blood pressure differences in children and adolescents.

An interarm difference (IAD) in blood pressure (BP) of 10 mmHg or more is a potential cardiovascular risk factor in adults, given its association with cardiovascular events/mortality. In children and adolescents, accurate BP assessment is critical for identifying risk of end organ damage. However, IAD has not been systematically studied in paediatric patients; if present and of significant magnitude, measuring BP in only one arm could lead to misclassification of hypertensive status. In 95 children/adolescents with a normal aorta (including 15 with a history of tetralogy of Fallot) aged 7-18 years attending the Royal Children's Hospital, Melbourne, we aimed to determine the magnitude of IAD, frequency of IAD of at least 10 mmHg, difference in BP classification between arms, and influence of repeat measures on IAD in a single visit. After 5 min rest, simultaneous bilateral BP was measured in triplicate with an automated device. Absolute systolic IAD was 5.0 mmHg (median, interquartile range 2-8 mmHg) and was 10 mmHg or more in 14%, with no change on repeat measures. In patients with a history of aortic surgery, IAD of 10 mmHg or more occurred in 27% (transposition of the great arteries, n = 15) and 75% (aortic coarctation, n = 8). Differences in BP classification, based on initial left vs. right arm measures, occurred in 25% (normal aorta) and 40%/63% (aortic surgery), or 17% and 33%/50%, respectively if second and third measurements were averaged. Substantial interarm BP differences were common, even in apparently healthy children and adolescents: evaluation of IAD may, therefore, be important for BP classification in the paediatric setting.

SIGNIFICANCE OF INTERARM PRESSURE DIFFERENCE AND STRESS- A CROSS SECTIONAL STUDY IN POLICE WORKER

Background: Interarm pressure difference more than 10 mm of Hg is predictor of cardiovascular and metabolic risk. There is high prevalence of obesity and stress in police personnel because of stressful working environment. With this background the present study conducted to access the relation of interarm blood pressure difference with stress in police personnel. Aims and Objective: To assess the prevalence of stress among police personnel and to see its association with interarm pressure difference. Material and Method: This cross-sectional observational study done on 245 police worker in PAC, Sitapur, India. Subjects having more than ten years of working experience were included in study. Anthropometric measurements of subject recorded by following standard protocol. Measurement of systolic pressure in both arm recorded simultaneously by mercury sphygmomanometer. Occupation related stress was measured by using preformed police stress questionnaire, each having 20 items. Result expressed as mild, moderate or severe stress. Available data analyse and expressed in percentage, mean with SD and chi square test to see the significance of association. Results: Study result showed that 34.29 percent of subjects showed abnormally high (?10 mmHg) inter-arm systolic blood pressure difference and shows high significant association with duration of service and with stress of police personnel. Conclusion: Interarm blood pressure difference is greater in individual having stress or prolong duration of service. Such subjects are more susceptible to develop cardiovascular or metabolic disorder in future. Early screening can help to detect the vascular events likely to occur in the future Keywords: Body mass index, Interarm pressure difference, Stress, shift worker

Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in Western Nigeria: Implication for diabetes prevention.

BackgroundFor many decades, hypertension guidelines recommended dual-arm blood pressure measurement. However, this practice is poor in Nigeria and its significance is largely unidentified. Hence, this study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus.MethodsA cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms.ResultsOne-hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents, respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents, respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8%, respectively. Significant systolic inter-arm difference (p = 0.033) and diastolic inter-arm difference (p = 0.01) were significantly more among respondents with hypertension and/or diabetes mellitus.ConclusionThe blood pressure readings in both arms were different among the majority of the respondents, being higher on the right arm in many of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.

Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration.

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. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.

English

BACKGROUND Blood pressure (BP) in the right and left arms can be different. This inter arm difference (IAD) in BP can be systolic (IAD - SBP) and / or diastolic (IAD - DBP). IAD of ≥ 10 mm of Hg is considered significant. SYNTAX score is used to assess the complexity of coronary artery lesions. Prevalence of IAD in patients undergoing coronary angiography (CAG) and its relationship to complexity of coronary artery disease is unclear. METHODS In 100 patients taken up for CAG, BP was recorded in both the arms simultaneously with automated devices using oscillometric method. Significant IAD was defined as ≥ 10 mm of Hg. Using SYNTAX score, patients were divided into two groups; those with a lower score &lt; 22 and those with a higher score ≥ 22. Data was analysed using SPSS version 16. Mean difference of the variables was analysed using Independent t test. Association of interarm BP difference and high SYNTAX score was analysed using Chi Square test. RESULTS Significant IAD of ≥ 10 mm of Hg was noted in 16 out of 100 patients. SYNTAX score of ≥ 22 was seen in 30 patients. IAD - SBP ≥ 10 was noted in 23.3 % in patients with higher SYNTAX score as against 2.9 % in those with lower score (p 0.001). IAD - DBP ≥ 10 was seen in 20 % of patients with higher SYNTAX score as against 1.4 % in those with lower SYNTAX score (p 0.001). CONCLUSIONS Interarm blood pressure difference of ≥ 10 mm of Hg is seen in 16 % of cases taken up for coronary angiogram. Patients with IAD ≥ 10 mm of Hg had higher SYNTAX score of ≥ 22 suggesting more complex coronary artery disease. KEYWORDS Interarm Blood Pressure Difference, SYNTAX Score

Association between inter-arm difference in SBP and central blood pressure in a Beijing community cohort.

The inter-arm SBP difference (IASBPD) can serve as a predictor of cardiovascular disease (CVD). In this study, we aimed to determine the relationship between IASBPD and central blood pressure (CBP). The study cohort comprised of 7842 eligible individuals. Their BPs were assessed simultaneously in both arms using an Omron BP-203RPEIII vascular profiler, and the IASBPD was measured as the absolute difference in these values (absolute value of left minus right). The CBP was noninvasively measured using an Omron HEM-9000AI device. Multivariate regression analysis was used to assess the association between the central SBP (cSBP) and the IASBPD. An IASBPD of ≥10 mmHg was positively associated with the cSBP (β = 2.26; 95% confidence interval, 1.04-3.48; P < 0.001). The interaction test showed no significant interactions between the IASBPD and any of the assessed covariates (age group; sex; BMI; smoking status; heart rate group; the presence of hypertension, diabetes, or CVD; and antihypertensive drug use) when the cSBP was used as the outcome in the subgroup analysis. The mechanism underlying the ability of the IASBPD to predict CVD may partly involve an increase in the CBP.

INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE IS ASSOCIATED WITH A HIGH PREVALENCE OF CARDIO VASCULAR DISEASES- A CROSS-SECTIONAL STUDY IN POLICE WORKER

Background: Interarm systolic blood pressure difference more than 10 mm of Hg is predictor of cardiovascular and metabolic risk. Despite of sufficient physical activity there is high prevalence of obesity in police personal because of stressful working environment. No studies have addressed the significance of interarm pressure difference among them. Therefore, the present study conducted to access the relation of interarm blood pressure difference with obesity in police personnel. Aims and Objective: To estimate the interarm pressure difference in police personal to see its association with their obesity. Material and Method: This cross-sectional observational study done on 245 police workers in PAC, Sitapur, India. Subjects having more than ten years of working experience were included in study. Anthropometric measurements of subject recorded by following standard protocol. Measurement of systolic pressure in both arm recorded simultaneously by mercury sphygmomanometer. Available data analyze and expressed in percentage, mean with SD and chi square test to see the significance of association. Results: According to anthropometric results of subjects 77.14 prcent subjects were having generalised obesity and 82.04 percent of subjects having abdominal obesity. 34.29 percent of subjects showed abnormally high (?10 mmHg) inter-arm systolic blood pressure difference. Both type of obesity showed positive association with blood sugar level but no association with interarm pressure difference. Conclusion: Interarm blood pressure difference is greater in individual having obesity or prolong duration of service. Such subjects are more susceptible to develop coronary artery disease or peripheral arterial disease in future. Early screening can help to detect the vascular events likely to occur in the future Keywords: Body mass index, Waist circumference, Interarm pressure difference, Random blood sugar

Abstract 13259: Differences in Glucose Readings Between Right Arm and Left Arm Using a Continuous Glucose Monitor

Introduction: Poorly controlled diabetes increases the risk of cardiovascular disease and associated complications. Continuous glucose monitoring (CGM) devices are tools that allow clinicians and patients to gather real-time glucose levels to enhance glycemic control. CGM devices are increasingly used to optimize diabetes management, but there is no guidance on whether glucose readings differ when a CGM device is placed on the right versus the left arm. We assessed the hypothesis that a difference in time-matched glucose levels will be observed between the right and left arm. Methods: This prospective trial enrolled 46 adult volunteers to simultaneously wear CGM sensors on the right and left arms. Glucose readings were collected every 15 minutes over a 12-14 days study period. To assess if any observed inter-arm differences were a result of perfusion, participants were randomized to perform a daily 20-minute unilateral arm exercise using an assigned arm on Days 1-6, and to use the alternate arm from Day 7 to Days 12-14. Differences in glucose readings between the right and left arm were compared using the paired sample t-test. Results: A total of 41,288 time-matched glucose level pairs were collected and the mean glucose reading in the right arm was higher than that of the left arm by 3.7±10.6 mg/dL (p&lt;0.001). Glucose readings were in hypoglycemic range (&lt;70 mg/dL) for 22.1% of the time in the right arm and 29.8% of the time in the left arm (p&lt;0.001), in euglycemic range (70-180 mg/dL) for 75.2% of the time in the right arm and 67.5% in the left arm (p&lt;0.001), and in hyperglycemic range (&gt;180 mg/dL) for 2.8% of the time in both arms (p=0.83). The difference in glucose levels between the arms was similar before and during exercise [4.0±10.2 mg/dL vs. 4.3±10.1 mg/dL, p=0.77]. Conclusions: In conclusion, glucose levels and time in hypoglycemia and euglycemia significantly differ based on arm selection during CGM device placement. This finding is unrelated to differences in perfusion induced by unilateral arm exercise. If these findings are further validated in patients with diabetes, arm selection during CGM device placement could impact therapy decisions, clinical trial design, and interpretation.