Inter-arm Difference Research Articles

Simultaneous double arm automated blood pressure measurement for the screening of subjects with potential vascular disease: a community study

Purpose: Hypertension guidelines recommend measuring blood pressure (BP) on both arms, since an abnormal inter-arm difference (IAD) in BP is associated with an increased risk of vascular abnormalities and cardiovascular (CV) disease. We tested whether an automatic oscillometric BP monitor allowing simultaneous both arm BP measurement might be effective for screening of subjects with potential vascular disease.Materials and methods: 220 consecutive subjects from an unselected sample of individuals of a small Italian community were screened using an automated upper-arm electronic BP monitor (Microlife WatchBP Office). Seated BP was measured in triplicate at 1 min interval. Demographic and clinical data were collected prior to any BP measurement. An average IAD difference >20 mmHg for systolic (S) and/or >10 mmHg for diastolic (D) BP was considered abnormal.Results: In 9 subjects (4.1%) an abnormal IAD was found, with lower BPs measured in the non-dominant arm (147 ± 28/78 ± 9 vs. 154 ± 15/92 ± 11 mmHg dominant, p<.01). Subjects with a significant IAD were significantly older (71 ± 8 vs. 57 ± 15 years, p=.005), had a greater body mass index (BMI: 32 ± 7 vs. 25 ± 4 kg/m2, p=.0001), higher BP levels (154 ± 15/92 ± 11 vs. 133 ± 18/80 ± 10 mmHg, p=.001) and were more likely to report obesity (56 vs. 13%, p=.001), a history of hypertension (67 vs. 35%, p=.044) or cardiovascular disease (33 vs. 10%, p=.034) than subjects with normal IAD. In a multivariate analysis, a higher BMI [odds ratio (95% confidence interval): 1.29 (1.11, 1.51)] and SBP [1.06 (1.01, 1.10)] were significantly associated with a larger risk of an abnormal IAD (p=.001 and p=.012, respectively).Conclusions: An abnormal IAD in BP is associated with a larger prevalence of CV risk factors and CV disease. Our study confirms that simultaneous both arm BP measurement must always be accomplished in subjects at risk for or with established CV disease.

Inter-arm differences in blood pressure among subjects with disseminated atherosclerosis scheduled for vascular surgery.

The measurement of blood pressure (BP) is routinely performed in perioperative care. The reliability of results is essential for the implementation of treatment ensuring haemodynamic stability. The aim of the present study was to assess the prevalence and basic determinants of inter-arm BP differences among patients with advanced peripheral atherosclerosis undergoing vascular surgical procedures of the lower limbs. The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. One-time non-invasive BP measurements were performed sequentially on the brachial arteries of both upper extremities before the induction of anaesthesia, maintaining the shortest possible interval between measurements. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded. The results of 173 patients (including 123 men aged 67 ± 8 years) were analysed. In 16 (9.3%) patients, an inter-arm difference in BP was already observed during the preoperative examination. SBP and DBP was higher in the right limb in 86 (49.7%) an 80 (46.3%) patients, respectively. Moreover, the medians of inter-arm differences in SBP, DBP and MAP were 9 (IQR 4-17), 5 (IQR 3-10) and 7 mm Hg (IQR 3-12), respectively. An evaluation of the determinants of BP differences related to the presence of additional diseases demonstrated that patients with arterial hypertension were characterised by higher SBP and MAP disproportions (P = 0.04 and P = 0.01). In the population of patients with disseminated atherosclerosis, the inter-arm differences in BP substantially exceed the measurement error limits and are likely to be associated with arterial hypertension. If in doubt about BP disproportions, intraoperative monitoring of BP should be recommended using an invasive method on the limb presenting higher non-invasively measured values.

A15480 Pattern of Inter-arm difference in blood pressure and ankle-brachial index in building construction workers

Objectives: Inter-arm blood pressure difference (IAD) has received increased attention recently since it has been found to be associated with peripheral vascular disease (PAD). An inter-arm difference in blood pressure of less than 10mmHg is classified as normal based on the new clinical guideline for hypertension. The ankle-brachial index (ABI) is the ratio of the systolic blood pressure at the ankle compared with the brachial artery pressure. When the ABI is ≤ 0.9, a diagnosis of PAD is made upto a 90% accuracy. Oscillometric blood pressure measurement is commonly used for screening and follow-up monitoring of arterial hypertension, may also used as automated tools for simplified ABI-measurements rather than pinpoint detection of a vessel by a Doppler probe. The purpose of present study is to see the pattern of inter-arm difference in blood pressure and also validate oscillometric ABI measurement by assessing and comparing the results with the current gold standard of Doppler assisted measurement of ABI in building construction workers Methods: Inter-arm difference in blood pressure and ABI was measured in 50 building construction workers with age group between 20- 40 years using Automated Oscillometric device Microlife watchBP office (model- Twin200 AFS), Switzerland with appropriate cuff size for arm and leg circumference. Doppler ABI measurements were made with a commercially available HI-dop (BT-200 vascular Doppler in all building construction workers. Results: Increased systolic inter-arm difference was present in significant number of participants. Oscillometric measurement of ABI was performed significantly faster than Doppler-assisted ABI. Conclusion: In primary care setting, blood pressure should be actively measured in both arms. Oscillometric ABI is feasible and operator- independent.

A10597 Characteristics of Four-limb Blood Pressure in Takayasuʼs Arteritis

Objectives: To explore the characteristics of four-limb blood pressure (BP) in Takayasu's arteritis (TA) and confirm the diagnostic value of simultaneously measuring four-limb blood pressure in TA. Methods: We consecutively analyzed 229 inpatients diagnosis with TA from January 2013 to January 2016 in Fuwai Hospital. The data of four-limb blood pressure was collected and compared in 229 TA patients and 150 patients with primary hypertension and 150 normal controls to explore the characteristics of four-limb blood pressure in TA patients. Results: 116 (51%) TA patients suffered from hypertension in the past. Peripheral angiography confirmed that 76 (33%) TA patients had arterial stenosis of upper limbs, in which 28 (12%) TA patients had arterial stenosis of both side upper limbs. 46 (20%), 62 (27%) and 18 (8%) TA patients had arterial stenosis of aorta, renal and low leg respectively. Echocardiography revealed that 53 (23%) TA patients had aortic regurgitation or regurgitation. However, the proportion of absolute inter-arm systolic blood pressure difference (IASBDP) > 10 mmHg, inter-ankle systolic blood pressure difference (IAND) > 10 mmHg, pulse pressure (PP) on the higher arm side of systolic pressure > 60 mmHg, ankle-brachial index (ABI) < 0.9 in TA patients were 54.3%, 20.0%, 48.0%, 27.3% respectively, which was significantly higher than primary hypertensive and healthy people (p < 0.01). There were 189 TA patients (83.3%), 49 primary hypertensive patients (19.3%) and 16 healthy people (10.7%) who met any above-mentioned indicators. Conclusion: Characteristics of four-limb blood pressure in TA patients is distinct. Compared with simple brachial artery blood pressure, simultaneous four-limb blood pressure provide concisely more valuable information which can increase the sensitivity of diagnosis of TA significantly.

The Relationship between Inter-Arm Blood Pressure Difference and Coronary Artery Disease Severity Calculated by the SYNTAX Score.

Objectives The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.

Abstract P206: Interarm Difference in Blood Pressure: Prevalence, Risk Factors, and Relevance for Diagnosis of Disease of the Aorta Among Patients Referred to Specialized Regional Hypertension Center

Background: Initial evaluation of hypertension (HTN) should include assessment of blood pressure (BP) in both arms. The prevalence of high interarm differ ranges from 3% in the general adult population to about 10% in the patients with HTN. However, we lack proper estimates of its prevalence, and existing practice of follow up for these patients in a referred population. Methods: We performed a retrospective chart review of all prevalent patients followed at the Hypertension Center at the Ottawa Hospital. BP data from the first visit were used for assessment for interarm BP difference. We considered interarm difference in either systolic or diastolic BP in excess of 10 mmHg for casual BP by mercury sphygmomanometry to be clinically significant. Results: 493 patients of 580 patients were included in this study based on available data. The prevalence of clinically significant interarm difference in systolic or diastolic BP was 16.2% and was similar among men and women. These patients were more likely to be smokers (current or previous; 53.5% vs 36.8%) with peripheral arterial disease (PAD, 15% vs 8%). None of these patients had undergone further investigations of ascending aorta/aortic arch. Conclusions: A significant proportion of referred patients have a high interarm difference in systolic or diastolic BP. No clinical investigations were ordered to evaluate for ascending aorta/aortic arch disease reflecting the physicians’ lack of understanding of its clinical relevance. The association with smoking and PAD suggests underlying aortic/large vessel disease as a potential mechanism in some patients.

Reference Values for Assessing Localized Hand Lymphedema Using Interhand Tissue Dielectric Constant Ratios.

Early detection and tracking of breast cancer treatment-related lymphedema have been helped by quantitative assessment methods and parameters, including bioelectrical impedance spectroscopy and tissue dielectric constant (TDC). Such measurements are evaluated with respect to interarm differences or ratios that (when exceeding specified thresholds) are suggestive of lymphedema. Specific threshold ratios depend on the assessment method and have been reported for arms. However, there is far less information available on thresholds to assess lymphedema that manifests in at-risk hands and essentially nothing known about TDC ratios in healthy hands. Such information is essential to establish reference values from which lymphedema threshold TDC values may be estimated. The specific aim of this research was to determine such interhand TDC ratios applicable to both young and mature women. A total of 70 women (35 under 30 years of age, YOUNG, and 35 over 50 years of age, MATURE) participated after signing an approved institutional review board informed consent. TDC values of the hand dorsum web were measured bilaterally in triplicate with participants in a supine resting position. Results showed MATURE TDC values to be about 15% less than YOUNG (p < 0.01) on dominant and nondominant hands, but no statistical difference in dominant/nondominant interarm ratios (1.026 ± 0.100). Based on this data set's overall mean and two standard deviation value, an age-independent interhand TDC threshold ratio of 1.23 emerges as potentially useful for lymphedema detection. This is a good initial start threshold that is usable in future clinical and research assessments.

INTER-ARM DIFFERENCES IN BLOOD PRESSURE AND MORTALITY

Objective: Study-level meta-analyses have associated inter-arm differences (IAD) in systolic blood pressure (SBP) with increased mortality. However key areas of investigation remain, such as determining the additional contribution of IAD to prognostic risk estimation for cardiovascular and all-cause mortality, and determining the minimum value for IAD that defines elevated risk. We are conducting an individual participant data (IPD) meta-analysis to address these questions. Design and method: Systematic review and IPD meta-analysis; we identified prospective studies that measured SBP in both arms during recruitment, and invited contribution of eligible datasets to the Collaboration. Study datasets were cleaned and combined into a single dataset for analyses. A non-random sample of four datasets were reserved for model validation; remaining data were analysed in fixed effect 1-stage meta-analyses with multivariable time-to-event regression modelling. Analyses of IAD dichotomised using cut-offs by 1mmHg increments from 0 to 20 mmHg, adjusted for age, gender and baseline SBP, were compared to identify a lower limit of IAD associated with increased all-cause mortality using random effects 2-stage models. Scientific Data: Searches to January 2017 yielded 4448 unique citations, 152 full texts were screened, 60 potentially relevant datasets were identified and their authors contacted. Data from 24 studies (57,434 eligible individual adult patients) were received. Results: In complete case analysis of 35,900 records (the derivation cohort), absolute systolic IAD was associated with increased all-cause mortality: fully adjusted hazard ratio (HR) 1.01, 95% confidence interval (95%CI) 1.00 to 1.02 per mmHg of IAD. Other significant model variables were age, gender, baseline SBP, current smoking, total cholesterol, ethnicity, and diagnoses of hypertension or diabetes. Incremental analyses of 50,661 records showed increasing HRs associated with rising IAD cut-offs, and suggested that an IAD of 7 mmHg or more is associated with increased risk of all-cause mortality. Conclusions: This IPD meta-analysis confirms the role of systolic IAD as an independent risk marker for all-cause mortality, with a threshold of 7 mmHg as a lower limit for increased mortality risk. We continue to model cardiovascular outcomes and will present full results to the meeting.

INTER-ARM BLOOD PRESSURE DIFFERENCE

Objective: An increased inter-arm systolic blood pressure difference (IBPD) is an easily determined physical examination finding and a significant IBPD has recently been associated with worse cardiovascular outcome. But the prevalence of IBPD in Asian population is unknown and the relationship between IBPD and blood pressure (BP) variability is not yet determined. This study was performed to describe the prevalence and clinical characteristics of the patients with increased IBPD and to examine the association between IBPD and BP variability.Design and method: A representative population (aged 20–65 years) was selected by list-assisted random-digit dialing method from a city with a population of one million. The BP of two arms was simultaneously measured using validated automatic BP measurement devices for 3 times and ambulatory blood pressure monitoring (ABPM) was performed in all included subjects. An increased IBPD was defined as > 10mmHg using the average of 3 BP differences obtained simultaneously in both arms. Results: Five hundreds of subjects were included in this study, and 13 subjects were excluded because of inadequate ABPM measurements. Mean age was 46.9 ± 9.4 years and 309 participants were female (63.4%). Overall systolic BP and diastolic BP were 118.5 ± 13.4 mmHg and 75.1 ± 10.3 mmHg and mean systolic IBPD was 5.7 ± 4.0mmHg. Of 487 subjects, 66 subjects (13.6%) had an increased systolic IBPD. Compared with those with normal IBPD, subjects with increased systolic IBPD showed higher clinic BP (127.2 ± 13.7 vs. 117.2 ± 12.8 mmHg in systolic BP, P < 0.001; 78.7 ± 11.2 vs. 74.6 ± 10.1 mmHg in diastolic BP, P = 0.002), higher 24-hour systolic BP (118.5 ± 12.0 vs. 115.6 ± 10.8 mmHg, P = 0.045) and higher 24-hour pulse pressure (42.4 ± 7.4 vs. 40.2 ± 6.5 mmHg, P = 0.012). The subjects with increased systolic IBPD showed higher 24-hour BP variability; increased standard deviation of daytime BPs, increased weighted standard deviation of BPs, increased coefficient of variation of daytime BPs and increased average real variability of both 24-hour BPs and daytime BPs (Table). There was no significant difference in nighttime dipping pattern of increased IBPD subjects. Conclusions: In this community-based cohort, an increased IBPD is common and associated with an increased short-term BP variability. Bilateral BP measurements should be emphasized in routine clinical practice.

Exercise Duration Augments Inter-Arm Systolic Blood Pressure Difference

Blood pressure is a universal measurement used to aid in appropriate clinical decision-making and monitor safe exercise participation. Inter-arm systolic blood pressure difference (ISBPD; difference of ≥10mmHg between arms) at rest is associated with vascular disease, arterial stiffness, and premature morbidity and mortality. The incidence ISBPD at rest is low (i.e. commonly reported as 10%), though the occurrence of ISBPD is known to increase with short-term (i.e. <5 min at 6 metabolic equivalents) moderate- intensity aerobic exercise. PURPOSE: To determine the exercise-induced ISBPD response during a prolonged steady-state bout of aerobic exercise. METHODS: Fifty-four individuals were studied on two separate occasions. On an initial visit, anthropometric measures and a VO2peak test on a cycle ergometer were completed. On a subsequent visit, participants cycled at a workload equivalent to 50% of their VO2peak for 30 min. Heart rate (HR) and systolic blood pressure difference (SBPD; measured sequentially using standard auscultation in both arms) were measured at rest, 5, 10, 20, and 30 minutes of exercise (EX-5, EX-10, EX-20, EX-30), and during an active recovery (AR). Descriptive and comparative (one-way ANOVA) statistics were generated. A binary logistic regression analysis was used to determine the change in the odds ratio (OR) of ISBPD given exposure to exercise. RESULTS: The incidence of ISBPD at rest was 19%. The occurrence of ISBPD increased to 35% at EX-5 and EX-10, and 46% at EX-20 and EX-30. Occurrence decreased to 20% during AR. Interestingly, each additional 1mmHg difference in SBPD at rest was associated with an increased OR of ISBPD at EX-5 (1.139), EX- 10 (1.335), EX-20 (1.220), and EX-30 (1.196; p<0.05). Individuals in the highest tertile of systolic blood pressure (SBP) response during exercise presented with the greatest SBPD (10.7 mmHg) at EX-5. Finally, individuals identified as underweight and obese class II were more likely to present with ISBPD at rest and EX-20. CONCLUSION: The occurrence of ISBPD during moderate-intensity aerobic exercise increased with prolonged steady-state aerobic exercise. Body mass index and the magnitude of the SBP response to exercise may be linked to ISBPD incidence.

The Association of Bilateral Pulse Wave Velocity and Inter‐Arm Systolic Blood Pressure Difference in Apparently Healthy Individuals

Bilateral, either simultaneous or sequentially measured, blood pressure (BP) is used for the screening and diagnosis of inter‐arm systolic blood pressure difference (ISBPD). ISBPD, wherein a difference of ≥10 mmHg in systolic BP between arms is noted, is associated with peripheral vascular disease, type 2 diabetes, and arterial stiffness. Similarly, arterial stiffness is a strong determinant of cardiovascular risk. Pulse wave velocity (PWV) is widely used as the gold‐standard measurement of arterial stiffness. However, bilateral PWV is not commonly performed, and procedural measurement of PWV has yet to achieve clear standardization. Further, existing evidence is very limited regarding the relationship of bilateral carotid‐radial PWV measurement and ISBPD.PURPOSETo determine the association between bilateral BP and carotid‐radial PWV.METHODSTo identify the relationship between bilateral carotid‐radial PWV measurement and BP, we studied 53 subjects (26±7.4 years, 57% female) with no known cardiovascular disease. Bilateral BP was acquired both sequentially (BPSEQ) and simultaneously (BPSIM) following a 10‐minute rest period in the supine position. Right and left carotid‐radial distances were measured using an Infantometer. Bilateral carotid‐radial PWV was obtained using a Complior Analyse™ simultaneously. T‐tests were performed to determine differences in BPSEQ and BPSIM and right and left carotid‐radial pulse wave velocity (PWVR; PWVL), and correlation coefficients determined the relationship between bilateral BP and PWV differences (PWVD).RESULTSBilateral BPSEQ and BPSIM measurement was similar (1.5±7.2 mmHg and 1.2±4.6 mmHg, respectively; P &gt; 0.05) and BP was not different between arms regardless of method (P &gt; 0.05). Interestingly, bilateral carotid‐radial PWV was different (PWVR = 7.8±1.3 m/s and PWVL = 7.3±1.1 m/s; P &lt; 0.05). BPSEQ and BPSIM is poorly correlated to PWVD (R = −.09 and R = .009, respectively; P &gt; 0.05). However, PWVR was strongly correlated to PWVD (R = .63; P &lt; 0.05).CONCLUSIONSGreater PWV is associated with a greater bilateral PWV difference. The consideration for bilateral measurement of PWV deserves further investigation. Bilateral BP and PWV differences may be valuable additions to a cardiovascular risk profile.Support or Funding InformationPennsylvania State System of Higher Education, Faculty Professional Development CouncilThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care

ObjectivesFalls are a common problem in older people. Postural hypotension contributes to falls but is often asymptomatic. In the absence of symptoms, postural hypotension is only infrequently checked for in...

Prediction of hemodialysis vascular access failure using segmental bioimpedance analysis parameters.

Segmental bioimpedance analysis (BIA) can identify fluid volume changes in the arms of patients on hemodialysis (HD) after vascular access surgery. We investigated whether the difference in fluid volumes between the arms of the patients using segmental BIA is associated with vascular access outcome. Body composition measurements were taken for 127 patients on HD with segmental, multi-frequency BIA equipment (InBody 1.0, Biospace Co. Ltd, Seoul, Korea). The difference in fluid volume between the arms of the patients was calculated from the fluid volume of the arm with the vascular access minus that of the other. The primary outcome was the loss of vascular access patency within 3months of BIA measurement. The median absolute and relative inter-arm fluid volume differences were 150ml [interquartile range (IQR) 90-250ml] and 9.6% (IQR 4.9-14.4%), respectively. Within 3months of BIA measurement, 38 patients (30.0%) experienced vascular access failure. When the patients were divided into three groups based on the tertiles of relative inter-arm fluid volume differences (lowest tertile:<6.8%; middle tertile: 6.8-12.7%; highest tertile:>12.7%), greater difference in relative inter-arm fluid volume differences was associated with higher vascular access failure rates (14 vs. 28 vs. 48%, p value for trend across tertiles=0.003). We conclude that segmental BIA may be used as a tool that can predict vascular access failure in patients on HD by calculating the relative difference in fluid volume between the arms of the patients with and without vascular access.

Interarm blood pressure difference, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in young adults

Background and Aim: Most recommendations on blood pressure (BP) measurement and hypertension have stated that BP should be measured in both arms and that the hand with the highest value should be used for subsequent measurements. It has been suggested that differences in the right and left arm pressures may be caused by undiagnosed peripheral vascular disease affecting the vasculature of upper limbs and may, therefore, predict an increased risk of cardiovascular disease. Methods: Simultaneous bilateral brachial BP measurements were taken after 10 min resting period in supine position; three BP measurements were taken simultaneously and automatically using a validated automatic oscillometric device (Microlife WatchBP office) at 1 min interval. Results: There were 22, 19, and 9 participants with interarm systolic BP difference of <5 mmHg, 5–9 mmHg, and ≥10 mmHg, respectively. Out of the total 50 participants, 29 (58%) had a positive family history of HTN/diabetes mellitus (DM). There was a positive association (P < 0.05) between interarm systolic BP difference ≥10 mmHg and positive family history of HT/DM. A statistically nonsignificant correlation was observed between basal metabolic index (r = 0.04), pulse pressure (r = −0.07), and mean arterial pressure (r = 0.23) with interarm systolic BP difference of both arms. Conclusion: The presence of interarm BP difference ≥10 mmHg and positive family history of hypertension and diabetes has a prognostic value in predicting cardiovascular events. Hence, in primary care setting, BP should be measured routinely in both arms using automated oscillometric device.

Evaluation of inter-arm difference in blood pressure as predictor of vascular diseases among urban adults in Kancheepuram District of Tamil Nadu.

Introduction:An “Inter-Arm Difference” (IAD) in blood pressure (BP) is defined as a variation in systolic BP of >10 mmHg. Various studies conducted in different population show that there are wide variations in the prevalence of IAD, which ranges from 5% to 46%. The aim of this study is to evaluate the prevalence of IAD in BP among adults and its association with risk factors.Methods:This community-based cross-sectional study was carried out among urban adults in Kancheepuram district. The study sample size of 1634 was calculated, and simple random sampling method was used. Data analysis was performed using SPSS software version 16. Prevalence of IAD in BP was calculated using percentages, and statistical significance was tested to look for an association.Results:This study shows that 26.2% were at moderate risk for vascular events with IAD in systolic BP of 10–15 mmHg and 17.3% were at high risk with IAD >15 mmHg. About 14.2% had diastolic BP difference of 10–15 mmHg indicative of moderate risk and 6.1% had a difference of >15 mmHg indicative of high risk for vascular events. The statistical significant association was found between IAD in systolic BP and risk factors such as hypertension, smoking, alcoholism, and between IAD in diastolic BP with overweight/obesity (P < 0.05).Conclusion:This study outcome shows that the prevalence of IAD in BP is on the higher side. Hence, specific guidelines should be brought in to practice for measuring BP in both arms to detect IAD in every health-care settings.

Inter-Arm Pulse Pressure Difference Superiority and Exercise-Induced Effect on it

Inter-Arm Pulse Pressure Difference Superiority and Exercise-Induced Effect on it

Factors associated with inter-arm blood pressure differences in patients admitted to critical care units

BackgroundExperts recommend obtaining one-time dual- (inter)-arm blood pressure (BP) measurements to predict cardiovascular morbidity risk. ObjectivesTo determine differences in inter-arm systolic (S)/diastolic (D) BPs obtained simultaneously and sequentially and examine associations between patient factors and clinical outcomes and inter-arm BP differences. MethodA comparative study of adults treated in intensive care; multivariable logistic models were created to determine the extent that inter-arm BP differences predicted outcomes. ResultsOf 427 adults in intensive care units, 31.8% had differences of >10 mmHg on simultaneous measurement and 35.1% had differences of >10 mmHg on sequential measurement; differences >15 mmHg were 17.9% and 19.8%, respectively. After controlling for patient factors, simultaneous inter-arm DBP differences >15 mmHg were associated with shorter hospital and longer intensive care length of stay (p = 0.031 and 0.029, respectively) and a 79% reduction in the likelihood of discharge to home (p = 0.009). ConclusionsSimultaneous inter-arm DBP differences >15 mmHg were associated with clinical outcomes.

Left subclavian artery malperfusion due to thoracic outlet syndrome during total vertebrectomy for invasive lung cancer: a case report

Thoracic outlet syndrome (TOS) can interrupt blood flow to upper limbs by vascular compression. We report a case of a 52-year-old man who presented left subclavian artery malperfusion due to TOS during total vertebrectomy (Th2–4) in the prone position for invasive lung cancer. At the time of resection of the vertebral bodies, his left radial systolic blood pressure had begun to drop intermittently and we noticed an interarm pressure difference. Accordingly, we began to monitor the right radial artery pressure and found that only the left radial artery pressure decreased as a result of compressive force from the surgical site. The operation was continued with intermittent malperfusion of the left arm, and when it was prolonged, we asked the surgeons to release the compression. No symptoms of ischemia or nerve injuries in the left arm were observed after the surgery. Retrospective review of his preoperative enhanced computed tomography images suggested a slightly compressed left subclavian artery in the costoclavicular space. Combination of the prone position and a specific upper limb position may be a risk factor for intraoperative TOS. An interarm blood pressure difference is a clue to detect accidental arterial TOS during general anesthesia.

PP.16.06] INTER-ARM BLOOD PRESSURE DIFFERENCE IN AN UNSELECTED HYPERTENSIVE POPULATION

Objective: Accurately measuring blood pressure in the office is many times challenging since a multitude of methodological issues have to be taken into account in the clinical setting where sequential measurement of blood pressure between arms, digit bias from physicians and rushing the required interval between measurements have produced in many cases faulty measurements. By using an automated machine with an integrated BP measuring protocol in the office we aimed to investigate the real prevalence of interarm difference (IAD) and investigate differences between hypertensive subjects with and without IAD. Design and method: We compared 82 consecutive patients of the hypertension outpatient clinic of a tertiary hospital (mean age = 59.7 ± 15.8 years, females n = 50). We used the Microlife Watch BP office afib which has a dual-cuff design for convenient, simultaneous measurements of IAD and an in-built protocol of waiting 1 minute before the measurements and also 1 min between measurements. This protocol cannot be violated by the physician. Anthropometric characteristics and patient history were recorded for all patients. We defined as clinically significant interarm difference of 10 mmHg. Results: The mean systolic blood pressure (SBP) IAD was 5.3 ± 4.9 and mean diastolic (DBP) IAD was 3.1 ± 2.5 mmHg. Fourteen patients (17.1%) had a clinically significant IAD of >10 mmHg. Interarm difference for pulse pressure (PP) was 5.5 ± 4.7 mmHg. Fourteen patients (17.1%) had PP difference >10 mmHg. There was no difference in the percentage of patients that higher BP in the left hand (53.7%) and on the right (46.3%) (chi square = 0.44, p = 0.5). Conclusions: Methodological issues hinder reliable BP measurements. Proper BP measurement produced a substantial number of patients with significant interarm difference. Differences in PP between arms should be investigated in terms of their clinical significance. Left and right arms showed similar percentages in dominance in regards to SBP.

BP.01.03] ASSOCIATION OF INTER-ARM BLOOD PRESSURE WITH AYSMPTOMATIC INTRACRANIAL AND EXTRACRANIAL ARTERIAL STENOSIS IN HYPERTENSION PATIENTS

Objective: Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites.Design and method: We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated for the presence and severity of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by the Vascular profiler 1000 device. Results: In the continuous study, ICAS was associated with age, male, average arm SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, the subjects with the top quartile of inter-arm DBP difference (>4 mmHg) showed significantly higher risk of ICAS (OR = 2.038; 95% CI, 1.347∼4.177). The risk of ICAS in patients with inter-arm DBP difference >= 5 mmHg was 103% higher (P = 0.009). And the participants with the top quartile of inter-arm SBP difference (>6 mmHg) showed higher risk of ECAS (OR = 2.031; 95% CI, 1.195∼3.452). The risk of ECAS in patients with inter-arm SBP difference >= 10 mmHg was 225% higher. Conclusions: In conclusion, we here reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study.