Inter-arm Difference Research Articles

Differences in glucose level between right arm and left arm using continuous glucose monitors.

BackgroundContinuous glucose monitoring (CGM) measures interstitial glucose levels through a sensor with a thin filament inserted under the skin. It is customary for patients to rotate sensor application sites between arms to minimize skin irritation. However, there is limited data regarding the degree of inter-arm differences with CGM technology.MethodsSelf-proclaimed right-handed (n = 5) and left-handed (n = 5) participants, regardless of concurrent comorbidities, were enrolled for CGM. Participants wore a FreeStyle Libre Pro sensor on each arm for a maximum of 14 days. Muscle mass and body fat analysis was conducted using a multi-frequency segmental body composition analyzer. Glucose levels from both arms were time-matched with the first 12 hours eliminated from analysis. Mean glucose and time in target range were compared between readings from the right and left arm.ResultsA total of 9830 paired glucose levels were included for analysis. In all participants (n = 10), mean glucose on the right arm was 89.1 mg/dL (SD, 19.9) and 85.3 mg/dL (SD, 19.3) on the left arm (P < 0.001). Glucose was out of target range (70-180 mg/dL) for 12.7% of the time in the right arm compared to 18.5% in the left arm (P < 0.001).ConclusionsIn a group of 10 nondiabetic and diabetic adults, there was a statistically significant difference in CGM readings between the right and left arms. Time in target range may differ based on arm selection when using a CGM. Arm dominance did not explain the inter-arm glucose level discordance.

Pulse Wave Analysis and Pulse Wave Velocity for Fistula Assessment

Background/Aims: Pulse wave analysis (PWA) and pulse wave velocity (PWV) provide information about arterial stiffness and elasticity, which is mainly used for cardiovascular risk stratification. In the presented prospective observational pilot study, we examined the hypothesis that radiocephalic fistula (RCF)-related changes of haemodynamics and blood vessel morphology including high as well as low flow can be seen in specific changes of pulse wave (PW) morphology. Methods: Fifty-six patients with RCF underwent local ambilateral peripheral PWA and PWV measurement with the SphygmoCor® device. Given that the output parameters of the SphygmoCor® are not relevant for the study objectives, we defined new suitable parameters for PWA in direct proximity to fistulas and established an appropriate analysing algorithm. Duplex sonography served as reference method. Results: Marked changes of peripheral PW morphology when considering interarm differences of slope and areas between the fistula and non-fistula arms were observed in the Arteria radialis, A. brachialis and arterialized Vena cephalica. The sum of the slope differences was found to correlate with an increased flow, while in patients with fistula failure no changes in PW morphology were seen. Moreover, PWV was significantly reduced in the fistula arm. Conclusion: Beside duplex sonography, ambilateral peripheral PWA and PWV measurements are potential new clinical applications to characterize and monitor RCF function, especially in terms of high and low flow.

Inter Arm Difference in the Blood Pressure and Pulse Rate in Young Adults

Inter Arm Difference in the Blood Pressure and Pulse Rate in Young Adults

Inter-arm Blood Pressure Difference as an Emergent Risk for Pre-hypertension

Objective: This study was aimed to determine the frequency of pre-hypertension and hypertension along with its association with inter-arm difference of blood pressure.Methodology: It was a cross sectional study conducted at Aziz Fatimah Medical and Dental College Faisalabad. Students of age ranged 19-21 years were enrolled by convenience sampling technique for screening of pre-hypertension and hypertension. Blood pressure was recorded from both arms by using sphygmomanometer and inter-arm differences were estimated. Mean±SD for continuous variables, frequency and percentages for categorical variables and chi square for association between pre-hypertension, hypertension and inter-arm difference was analyzed by SPSS 21.Results: Study comprised of 100 students with mean age 19.79±1.18 years. Of total 47% were females and 53% was male population. Mean systolic (p value =0.0002*) and diastolic (p value =0.000*) blood pressure of the two arms were significantly different. Of total population, 27% and 13% of population had pre-hypertension and hypertension respectively. Mean systolic inter-arm difference was significantly higher among the hypertensive subjects as compared to pre-hypertensive subjects, (p value =0.0001*). No significant difference was noted with respect to diastolic inter-arm difference (p value =0.93). Greater percentage of normotensive subjects have systolic inter-arm difference &lt;10mmHg as compared to this most of the subjects with hypertension and pre-hypertension have systolic inter-arm difference of &gt;15mmHg. Significant association between hypertension and systolic inter-arm difference was noted (p value =0.025)Conclusion: Pre-hypertension and hypertension is prevalent among young adults. High systolic inter-arm difference was significantly associated with pre-hypertension and hypertension.

Interarm blood pressure measurement and the reference-arm assignment variability

The arm with the higher blood pressure (BP) is assigned as the follow up arm for hypertensive patients (reference-arm). We evaluated the reproducibility of this assignment. BP was measured simultaneously on both arms with a double cuff validated device in two visits separated <10 days (two sets of three readings per visit). Two reference-arms were assigned in each visit (the arm with higher BP, at least ≥1 mmHg). The intravisit and intervisit agreements of this assignment were evaluated. We included 313 hypertensive patients. First visit mean right arm BP was 131.6 (16.6)/75.3 (9.4) mmHg and left arm BP was 132.4 (16.9)/75.7 (9.7) mmHg (P = 0.002). Intravisit concordance at the first and second visits were κ = 0.60 [95% confidence interval (CI), 0.516-0.696] and κ = 0.45 [95% CI, 0.356-0.555], respectively. Therefore, 21.8% of patients (at the first visit) and 29.1% (at the second visit) with the right arm as the reference-arm in the first round of readings changed to the left arm in the same visit in the second round of readings. The intervisit κ index was 0.25 [95% CI, 0.147-0.365]. After that, 36.8% of patients with the right arm as the reference-arm at the first visit changed to the left arm at the second visit. The subgroup (9.5%) with an interarm systolic BP difference ≥10 mmHg at the first visit did not differ significantly from the rest of patients. The reference-arm assignment agreement is weak to moderate. The assignment of the reference-arm should be individualized and not considered as definitive.

Longitudinal association between adiposity and inter-arm blood pressure difference.

This is the first longitudinal study evaluating whether adiposity is associated with inter-arm blood pressure difference. We evaluated 714 overweight/obese individuals aged 40-65years over a 3-year follow-up. Systolic and diastolic blood pressures were measured in both arms simultaneously using an automated machine. Linear regression assessed the associations of body mass index, fat %, waist, neck, thigh, and arm circumferences (cm), with absolute inter-arm differences in systolic (IAS) and diastolic (IAD) blood pressure (mmHg). Poisson regression was used for binary outcomes (IAS and IAD≥10mmHg). All models were adjusted for age, gender, smoking, physical activity, and HOMA-IR. Adiposity measures were associated with increased IAS and IAD (β range: 0.09-0.20 and 0.09-0.30). Neck circumference showed the strongest association with IAS (β=0.20, 95% CI: 0.03, 0.37) and IAD (β=0.30, 95% CI: 0.12, 0.47); arm circumference showed a similar association with IAS, but lower with IAD. Highest quartiles of BMI, thigh, and arm showed significant associations with IAS (IRR: 2.21, 2.46 and 2.70). Highest quartiles of BMI, waist, neck, and arm circumferences were significantly associated with IAD (IRR: 2.38, 2.68, 4.50 and 2.24). If the associations are corroborated in other populations, adiposity may be an important modifiable risk factor for inter-arm blood pressure difference with a large potential public health impact.

Inter-arm Blood Pressure Difference is Associated with Recurrent Stroke in Non-cardioembolic Stroke Patients

Recurrent stroke increases mortality and aggravates the disability of stroke patients. We hypothesized that increased inter-arm systolic blood pressure difference and inter-arm diastolic blood pressure difference would be related to recurrent stroke in non-cardioembolic stroke patients. A total of 1226 consecutive non-cardioembolic first-ever ischemic stroke patients, in whom bilateral brachial blood pressures were measured by an automated ankle-brachial index measuring device, were included in our study. Recurrent stroke was defined as newly developed neurologic symptoms with relevant lesions on brain CT and/or MRI after 7 days or hospital discharge. Inter-arm systolic and diastolic blood pressure differences ≥10 mmHg were noted in 9.7% (120/1226) and 5.0% (62/1226) of patients, respectively. During a median 24 months of follow-up, 105 (8.5%) patients experienced recurrent stroke. Patients who had inter-arm systolic blood pressure difference ≥10 mmHg showed increased risk of recurrent stroke (hazard ratio:1.77, 95% confidence interval: 1.04–3.00, p = 0.033). Moreover, inter-arm diastolic blood pressure difference ≥10 mmHg was also independently associated with increased risk of recurrent stroke (hazard ratio:2.92, 95% confidence interval: 1.59–5.34, p = 0.001). In conclusion, inter-arm blood pressure difference ≥10 mmHg may be associated with increased risk recurrent stroke in non-cardioembolic stroke patients.

Inter-Arm And Inter-Leg Blood Pressure Differences And Cardiovascular Outcomes In Patients After Percutaneous Coronary Intervention

Background and Aims: The implication of inter-leg BP difference has not been well studied. In this study, we investigated whether inter-arm and -leg BP differences have a prognostic value in patients undergoing percutaneous coronary intervention (PCI).

INTER-ARM BLOOD PRESSURE DIFFERENCE AND MORTALITY – EPIDEMIOLOGY OF HYPERTENSION IN CROATIA (EHUH STUDY)

Objective: Inter-arm blood pressure (BP) difference is associated with higher cardiovascular (CV) risk and increased mortality. The aim of this study was to obtain data on prevalence of inter-arm difference and association with all-caused and cardiovascular (CV) mortality in a random sample of Croatian general population. Design and method: EHUH study is nation-wide survey on prevalence, treatment and control of hypertension in Croatia. In 2001–2003 a random sample of 1267 subjects (men 40.8% mean age 53.1) were enrolled. Mortality data were analyzed after average period of 17 years. Office blood pressure (BP) was measured in sitting position using mercury sphygmomanometer three times at two visits and once at home visit: total 9 measurements -average BP values were calculated. Optimal, normal, high normal BP, untreated and treated hypertension (HT) were diagnosed in 20.9%, 15.3%, 12.9%, 19.1% and 31.5%, respectively During the first visit BP was measured at both arms. Subjects were divided into 2 groups: individuals with inter-arm BP difference of 10 mmHg or more and those with lesser difference Mortality data were collected from National Public Health Institute records. Results: In the whole group inter-arm difference was found in 23.4% subjects (m22.7% vs w 15.8%; X2 = 2.954; p = 0.008). Inter-arm difference was significantly more frequently observed in hypertensives vs. normotensives (29.5% vs 22.5% X2 = 24.9; p = 0.00000). There were no differences in inter-arm difference among BMI categories. We failed to find difference in all-cause mortality between subjects with > or <10 mmHg inter-arm difference (X2 = 2.114; p = 0.145). However, significantly more CV death occurred in those with inter-arm difference > 10 mmHg (73.8% vs 53.4% X2 = 3.833;p = 0.05). There were more CV deaths in uncontrolled patients with inter-arm difference >10 mmHg vs. controlled hypertensives patients with inter-arm difference >10 mmHg (77% vs 52%; X2 = 4.773; p = 0.028) Conclusions: Inter-arm BP difference was found in large number of general population. It was associated with higher CV mortality particularly in uncontrolled hypertensives. Inter-arm BP difference should be considered as a prognostic CV risk factor.

IMPACT OF INTER-ARM BLOOD PRESSURE DIFFERENCE ON CARDIOVASCULAR RISK ESTIMATION IN PRIMARY CARE

Objective:The Inter-arm blood Pressure difference Individual Patient Data (INTERPRESS-IPD) Collaboration recently demonstrated, based on data from over 57,000 records, that an inter-arm difference in systolic blood pressure (IAD) is an independent risk marker for cardiovascular events after adjustme

INTER-ARM BLOOD PRESSURE DIFFERENCE

Objective: Differences in systolic blood pressure (BP) between arms are associated with excess mortality and cardiovascular events. Inter-arm difference (IAD) has been attributed to both subclavian stenosis and to arterial stiffening, however the patho-physiological basis of IAD has not been established. We explored cross-sectional associations of systolic IAD (sIAD) within the INTERPRESS individual participant data (IPD) Collaboration to gain further insight. Design and method: The INTERPRESS-IPD Collaboration pooled records for 57,434 participants across 24 studies from Europe, North America, East Asia and Africa. We used hierarchical IPD linear regression with random effects for study, to perform univariable and multivariable models, examining cross-sectional associations of sIAD with known markers of cardiovascular risk. IAD was based on a single pair of BP readings. Models were compared using Aikeke's information criterion (AIC) and likelihood ratios (LR). Analyses were undertaken using Stata v15.0. Results: Complete data existed for 43,488 participants from 22 cohorts. Ankle brachial index (ABI) was negatively correlated with sIAD: coefficient −0.69 mmHg per 0.1 increment of ABI (−0.65 to −0.4; p < 0.001; figure). On multivariable modelling, magnitude of sIAD was positively associated with smoking (p = 0.04), age (p = 0.05), body mass index (p < 0.001), and systolic BP (p < 0.001). sIAD was lower for African American (p = 0.04) and Hispanic American (p < 0.01) participants compared to White ethnicity, and lower for men than women (p = 0.02). Using all available case data then multivariable model was confirmed. Goodness of fit improved on taking account of pre-existing cardiovascular disease (LR p = 0.004; n = 41,664), with addition of pulse pressure (LR p < 0.001; n = 33,844) or on adjustment for renal disease (LR p < 0.001; n = 15,541). AIC was non-discriminatory between models.Conclusions: This large multivariable analysis confirms the independent association of sIAD with recognised cardiovascular risk markers normally associated both arterial stiffening and with occlusive arterial disease. It is likely that both conditions make a contribution to the aetiology of IAD. These findings can support further hypothesis generation and study design.

SIGNIFICANCE OF THE COMBINATION OF VARIOUS INTER-LIMB BLOOD PRESSURE DIFFERENCES IN THE ELDERLY

Background and Objective: Whether the combination of inter-arm and inter-leg systolic blood pressure differences (BPDs) and ankle-brachial index, is of clinical significance remains unclear. The aim of this study is to investigate the association of the combination of inter-limb systolic BPDs with cardiovascular risk factors and hypertension mediated organ damage.Design and method: Methods: A total of 2621 elderly subjects (mean age 71.9 ± 6.2 years) derived from the Northern Shanghai Study were divided into Group A, B and C which consisted of participants with 0, 1 and 2 or more abnormal inter-limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular and renal damage among groups and logistic regression models were conducted. Results: The proportions of subjects presenting 0, 1 and 2 or more abnormal inter-limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Increasing trends from Group A, through Group B, to Group C, were observed for the level and prevalence of nearly all cardiovascular risk factors and hypertension mediated organ damage (P for trend <0.008 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (versus Group A: Odds ratio [OR] = 1.88, 95% Confidence Interval [CI] = 1.43–2.48; versus Group B: OR = 1.46, 95%CI = 1.08–1.97), arterial stiffness (versus Group A: OR = 1.26, 95%CI = 0.96–1.65; versus Group B: OR = 1.36, 95%CI = 1.01–1.83) and left ventricular hypertrophy (versus Group A: OR = 1.35, 95%CI = 1.04–1.76; versus Group B: OR = 1.25, 95%CI = 0.93–1.67), when compared with Group A and B. Conclusions: The combination of inter-limb systolic BPDs significantly associated with greater burden of cardiovascular risk factors and higher likelihood of hypertension mediated organ damage, especially carotid plaque, arterial stiffness and left ventricular hypertrophy. These findings suggest that the combination of abnormal inter-limb systolic BPDs may be of important clinical significance

Significance of the combination of inter-limb blood pressure differences in the elderly: The Northern Shanghai Study.

Whether the combination of inter-arm and inter-leg systolic blood pressure differences (BPDs) and ankle-brachial index is of clinical significance remains unclear. In this study, we aimed to investigate the association of the combination of inter-limb systolic BPDs with cardiovascular risk factors and hypertension-mediated organ damage (HMOD). A total of 2621 elderly subjects from the Northern Shanghai Study were divided into Group A, B, and C consisting of participants with 0, 1, and ≥2 abnormal inter-limb systolic BPDs, respectively. Comparisons of cardiovascular risk factors and parameters of cardiac, vascular, and renal damage between groups and logistic regression models were conducted. The proportions of subjects presenting 0, 1, and ≥2 abnormal inter-limb systolic BPDs were 60.9%, 25.1%, and 14.0%, respectively. Upward trends, from Group A, through Group B, to Group C, were observed for the level or prevalence of nearly all cardiovascular risk factors and HMOD (P for trend ≤0.007 for all). In multiple logistic regression, Group C showed significantly higher odds for carotid plaque (vs Group A: Odds ratio [OR]=1.88, 95% confidence interval [CI]=1.43-2.48; vs Group B: OR=1.46, 95% CI=1.08-1.97), arterial stiffness (vs Group A: OR=1.26, 95% CI=0.96-1.65; vs Group B: OR=1.36, 95% CI=1.01-1.83), and left ventricular hypertrophy (vs Group A: OR=1.35, 95% CI=1.04-1.76; vs Group B: OR=1.25, 95% CI=0.93-1.67), when compared with Group A and B. In conclusion, the combination of abnormal inter-limb systolic BPDs significantly associates with greater burden of cardiovascular risk factors and higher likelihood for HMOD, especially carotid plaque, arterial stiffness, and left ventricular hypertrophy.

Acute Handgrip Exercise Alters the Inter-arm Systolic Blood Pressure Difference in Young Males and Females

A large inter-arm difference (IAD) in systolic blood pressure (BP) is linked to an increased likelihood of cardiovascular and peripheral vascular disease, hypertension, and premature mortality. An acute bout of aerobic exercise can alter IAD both during the activity and into post-exercise recovery. Isometric handgrip exercise (IHE) results in acute alterations in BP that differ from aerobic exercise. Further, sex differences in IHE-mediated BP exist, and cardiovagal modulation is a plausible mechanism. No prior investigations have examined IAD during IHE in males and females. PURPOSE: To characterize IAD and heart rate variability (HRV) to IHE in men and women. METHODS: On visit one, participants completed three maximal voluntary isometric contractions (MVIC) per arm using a handgrip dynamometer. During visit two, after a five-minute rest, resting HRV was assessed while each participant breathed at a rate of 12 breaths/minute. HRV analysis software was used to determine relative low- and high-frequency power for each participant. Subsequently, a series of three resting bilateral BP measures were collected and averaged (REST) utilizing an automatic oscillatory BP device. Following REST, participants maintained the handgrip dynamometer at 20% MVIC for two minutes (arm randomly assigned), at which time bilateral BP and HRV were again measured (IHE). An independent-samples t-test and repeated measures ANOVA were used to compare and track variables of interest. RESULTS: IHE resulted in increased IAD in both males and females. Males demonstrated higher IAD at REST (7±6 vs. 3±3 mmHg) and during IHE (12±9 vs. 5±4 mmHg) than their female counterparts (P<0.05), with males also expressing a lower high-frequency HRV at rest (P<0.05). CONCLUSIONS: Isometric handgrip exercise altered IAD from rest to exercise, with males displaying increased IAD during both conditions. The attenuated exercise pressor response observed in female participants may be due, in part, to a higher observed baseline of cardiovagal modulation. Future studies should address potential responses following repeated bouts of IHE, which may have important implications in those with IAD.

957-P: Differences in Glucose Level between Left Arm and Right Arm Using Continuous Glucose Monitors

Background: Continuous glucose monitoring (CGM) is an emerging technology that provides real-time interstitial glucose levels through a sensor with a thin filament inserted under the skin. It is customary for patients to rotate sensor application sites between arms to minimize skin irritation. However, the degree of inter-arm differences with CGM technology remains unknown. Materials and Methods: Self-proclaimed right-handed (n=5) and left-handed (n=5) subjects, regardless of concurrent comorbidities, were enrolled for CGM. A FreeStyle Libre Pro Flash Glucose Monitoring System sensor was simultaneously placed on each arm for all subjects. The sensors were worn for a maximum of 14 days with measurements taken every 15 minutes. Muscle mass and body fat analysis was conducted using a multi-frequency segmental body composition analyzer. Glucose levels from the right and left arms were time-matched with the first 12 hours eliminated from analysis. Results: A total of 9830 paired glucose levels were included for analysis. Glucose levels were outside the euglycemic range (70-140 mg/dL) for 14.5% of the time in the right arm compared to 20.0% in the left arm (P&amp;lt;0.001). The glucose level in the right arm was higher than the left arm in 67% (range 46 - 98%) of the measurements (P&amp;lt;0.001). The absolute difference in glucose level between the right and left arms was &amp;gt;10 mg/dL, &amp;gt;20 mg/dL, and &amp;gt;30 mg/dL, for 19.4%, 3.4%, and 0.32% of the time, respectively. The mean glucose level in the right arm was higher than the left arm by 3.75 mg/dL [SD, 8.51 mg/dL] in right-handed subjects, and by 3.84 mg/dL [SD, 7.09 mg/dL] in left-handed subjects (P=0.54). Conclusion: Time in euglycemic range could significantly differ based on arm selection when using a CGM. While the absolute difference in glucose levels between arms appears small, this degree of variability would have significant implications for clinical trial design using CGM technology. Arm dominance does not explain the inter-arm glucose level discordance. Disclosure N. Kim: None. K. Pham: None. A. Shek: None. J.J. Lim: Employee; Self; Genentech, Inc. Stock/Shareholder; Self; F. Hoffmann-La Roche Ltd. S.A. Shah: None. Funding University of the Pacific

The impact of blinding on patient-reported outcomes (PROs) in randomized controlled trials of immune checkpoint inhibitors versus traditional chemotherapies.

e23160 Background: Immune checkpoint inhibitors (ICIs) have been met with a wave of excitement due to their novel mechanism. We hypothesized that this may impact how patients (via PROs) report treatment tolerability in comparison to traditional therapies. We sought to examine if there was a notable difference in PROs in blinded vs unblinded trials of ICIs. Methods: We systematically searched PubMed, CINAHL, Embase, Web of Science, and Scopus in August 2018 for publications with quantitative PRO data comparing ICIs to cytotoxic chemotherapy. Case series, narrative reviews, and publications lacking original data were excluded. Eligible publications were reviewed to assess if patients were blinded to the agent received, and a comparison for common PRO metrics was performed. Results: Of the 1,450 unique references identified, eight met inclusion criteria: 1 double blinded placebo-controlled trial and 7 trials where patients were aware of the assigned arm. The blinded trial had quantitative PRO data in the form of the European Organisation for Research and Treatment of Cancer (EORTC) global health status (GHS) score and patient reported symptom burden at week 12. Most (6 of 7; 86%) unblinded trials reported the GHS at either week 12 or 15, and patient symptom burden at these time points as well (5 of 7; 71%). For the EORTC GHS, the blinded trial showed no inter-arm difference at week 12. 4 of 6 (67%) open label trials noted statistically significant differences in GHS favoring the ICI arm. For symptom burden at week 12 or 15, there was no difference found in the blinded study. In unblinded trials, there were domains where patients receiving ICIs reported a statistically significant lower symptom burden than those receiving chemotherapy: fatigue (4 of 5 trials favoring ICIs; 80%), dyspnea (2 of 5; 40%), insomnia (1 of 4; 25%), appetite loss (1 of 4; 25%), and diarrhea (1 of 5; 20%). There were no differences in pain (n = 5), nausea/vomit (n = 5), and constipation (n = 5). Conclusions: We found a trend towards more favorable reporting on common symptoms in unblinded studies of patients receiving ICIs. Our analysis is limited by the lack of available comparisons in the published literature.

The ankle brachial index exhibits better association with cardiovascular outcomes than interarm systolic blood pressure difference in patients with type 2 diabetes.

Increased interarm systolic blood pressure difference (IASBPD) is associated with cardiovascular prognosis in the general population. This study aimed to evaluate whether IASBPD or ankle brachial index (ABI) is strongly associated with cardiovascular outcomes in patients with type 2 diabetes.Total 446 type 2 diabetes followed up for a mean 5.8 years divided by ABI (<0.9 vs ≥0.9) or IASBPD (<10 vs ≥10 mm Hg). The primary outcome was a composite of all-cause mortality, hospitalization for coronary artery disease, nonfatal stroke, carotid, or peripheral revascularization, amputations, and diabetic foot syndrome. The secondary endpoint was all-cause mortality.Sixty-four composite events and 17 deaths were identified. The primary and secondary outcomes were higher than those in the group with ABI < 0.9 vs ABI ≥ 0.9 (32.8% vs 11.6%, P < .005 for primary outcome; 14.0% vs 2.3%, P < .005 for all-cause mortality) but IASBPD cannot exhibit a prognostic value. ABI < 0.9 was also the dominant risk factor of both endpoints demonstrated by multivariate Cox proportional analysis (composite events: adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.26–4.53; P = .007; all-cause mortality: adjusted HR, 3.27: 95% CI, 1.91–5.60; P < .001).The ABI was more associated with cardiovascular outcomes in patients with diabetes than IASBPD.

Four-Limb Blood Pressure Measurement with an Oscillometric Device: a Tool for Diagnosing Peripheral Vascular Disease.

Traditionally, the term peripheral vascular disease (PAD) is restricted to the occlusive arterial disease in the leg, but now, the connotation of PAD is more widespread as it encompasses all extracoronary and extracerebral vascular disease. The incidence of PAD is increasing worldwide; therefore, it is necessary to diagnose PAD at an early stage. Oscillometric BP device is widely used for four-limb measurement in clinical practice and provides several parameters for evaluating inter-limb BP difference, such as ankle-brachial index (OS-ABI), inter-arm BP differences (IAD), and inter-ankle BP difference (IAND). Using angiographic results as reference, the ABI, IAD, and IAND from an oscillometric BP device have been demonstrated having high accuracy for diagnosis of PAD. Meanwhile, combination of these parameters could further improve the accuracy of PAD, including the occlusive artery disease in the arm, leg, and aorta. For example, some patients with severe PAD in the leg have normal ABI; in this situation, an increased sIAND could confirm the diagnosis of PAD in the leg. Because ABI, IAD, and IAND from inter-limb oscillometric BP measurement can also predict adverse prognosis, we encourage the use of an oscillometric device to measure four-limb BP and to evaluate the inter-limb BP difference.

Interarm Blood Pressure Difference has Various Associations with the Presence and Burden of Cerebral Small-Vessel Diseases in Noncardioembolic Stroke Patients.

Background and PurposeAn interarm blood pressure difference (IABD) is independently related to the occurrence of cardiovascular disease and mortality. Cerebral small-vessel diseases (SVDs) are important risk factors for stroke, cognitive dysfunction, and mortality. We aimed to determine whether IABD is related to cerebral SVDs.MethodsThis study included 1,205 consecutive noncardioembolic ischemic stroke patients as confirmed by brain MRI and simultaneously measured the bilateral brachial blood pressures. We investigated cerebral SVDs based on high-grade white-matter hyperintensities (HWHs), presence of cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs) on brain MRI.ResultsIn multivariate logistic regression, an interarm systolic blood pressure difference (IASBD) ≥10 mm Hg was independently related to the existence of HWHs [odds ratio (OR)=1.94, 95% CI=1.32–2.84, p=0.011] and had a tendency to be associated with the presence of HPVSs (OR=1.45, 95% CI=0.49–2.23, p=0.089) and ALIs (OR=1.42, 95% CI=0.96–2.11, p=0.052), but not with the presence of CMBs (OR=1.09, 95% CI=0.73–1.61, p=0.634). In multivariate linear regression adjusted for age, sex, and variables with p<0.1 in the univariate analysis, IASBD ≥10 mm Hg and interarm diastolic blood pressure difference ≥10 mm Hg were significantly correlated with an increased total burden of SVDs (β=0.080 and p=0.006, and β=0.065 and p=0.023, respectively).ConclusionsThis study found that IABD ≥10 mm Hg was associated with the presence and increased burden of cerebral SVDs in noncardioembolic stroke patients. This suggests that IABD ≥10 mm Hg could be a useful indicator of the presence and burden of cerebral SVDs in stroke patients.

Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy.

IntroductionThe aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy.MethodsA total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%.ResultsOf the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01).ConclusionPatients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.