Interarm Systolic Blood Pressure Difference Research Articles

Abstract 514: Development and Validation of Risk Model for Predicting Prevalence of Peripheral Artery Disease in a Low to Intermediate Risk Population

Background: Peripheral artery disease (PAD) is associated with impaired quality of life and significant cardiovascular morbidity and mortality, yet remains under recognized and under diagnosed. Objectives: This study sought to develop and validate a risk model for the identification of individuals at risk for PAD that could be useful in the clinical setting. Methods: Twenty three variables assessed in ≈3.2 million self-referred participants without established cardiovascular disease from 2003 to 2008 who completed a medical and lifestyle questionnaire in the United States were evaluated by screening ankle brachial indices <0.90 for PAD. Subjects were divided into a derivation cohort (1.57 million) and a validation cohort (1.57 million). Lasso variable selection was used in the derivation cohort to develop the best-fitting parsimonious prediction models. Discrimination and calibrations was evaluated using the C statistic and the Hosmer-Lemeshow calibration statistic. Results: The overall prevalence of PAD was 3.96%. Using lasso variable selection, 11 variables were included in complex best-fitting model: age, sex, race, marital status, BMI group, smoking status, hypertension, diabetes, family history of PAD, physical activity, and inter-arm systolic blood pressure difference. In the validation cohort, the C-statistics for this model was .746 and the calibration was excellent (P=0.38; no significant deviation between predicted and observed outcomes). The current risk score has improved discrimination and calibration compared with other existing risk scores for PAD. Conclusion: This robust PAD risk calculator derived from a diverse population across the US provides a good risk estimate of PAD and is anticipated to assist in identifying subjects at risk for PAD.

The inter-arm systolic blood pressure difference and risk of cardiovascular mortality: A meta-analysis of cohort studies

The inter-arm systolic blood pressure difference (SBPD) is recommended to be in relation to potential cardiovascular disease (CVD). Previous studies yielded controversial results about the association between an inter-arm SBPD ≥ 10 mmHg or ≥15 mmHg and the risk of cardiovascular mortality. Therefore, we conducted this meta-analysis to investigate this association. We searched PubMed and Embase databases through December 31, 2014, and examined the references of retrieved articles to identify relevant cohort studies. We utilized Newcastle–Ottawa scale to assess the quality of included studies and calculated the summary risk estimates in a fixed/random-effect model. All data analyses were conducted using STATA version 11.0. A total of seven studies were identified. Compared with participants with an inter-arm SBPD < 10 mmHg, the pooled hazard ratio (HR) of CVD mortality of those with an inter-arm SBPD ≥ 10 mmHg was 1.58 (95% CI: 1.3–1.93)，and the pooled HR of cardiovascular mortality of participants with an inter-arm SBPD ≥ 15 mmHg versus those with an inter-arm SBPD < 15 mmHg was 1.88 (95% CI: 1.33–2.66). The findings from the present meta-analysis indicated that the detection of an inter-arm SBPD may define a subpopulation at high risk of CVD events.

Inter-arm Blood Pressure Difference and its Relationship with Retinal Microvascular Calibres in Young Individuals: The African-PREDICT Study

Bilateral systolic blood pressure (SBP) differences > 10mmHg is a common finding in clinical practice. Such BP differences in older individuals are associated with peripheral vascular disease, linked to microvascular dysfunction. Investigating retinal vessel calibres could provide insight into systemic microvascular function and may predict cardiovascular outcomes. Therefore we investigated the link between inter-arm systolic blood pressure differences (IASBPD) and the retinal microvasculature to determine the usefulness of IASBPD as an early marker of microvascular changes. In this cross-sectional study, we used data from 403 apparently healthy participants (20-30 years) (42% men; 49% black) taking part in the African-PREDICT study. Participants underwent retinal vessel imaging, anthropometric measurements and blood sampling. Brachial BP was measured sequentially in both arms to determine the mean IASBPD. Participants were stratified into two groups with an IASBPD < 10mmHg (n=329) and ≥ 10mmHg (n=47), the only difference in characteristics being a higher right arm SBP in the latter group (p=0.005). We found no association between IASBPD and retinal vessel calibres in any group. Less than 2% of the variance in IASBPD was explained by potential risk factors, with only SBP associating independently with IASBPD (β=115; p=0.039). In a young population an increased IASBPD is not related to retinal vessel diameters suggesting that it does not reflect early microvascular alterations.

Interarm systolic blood pressure difference is associated with myocardial injury after noncardiac surgery.

Myocardial injury after non-cardiac surgery (MINS) is closely related to increased cardiovascular mortality. To evaluate the relationship between MINS and interarm systolic blood pressure difference (IASBPD), which has previously been shown to correlate with the frequency of cardiovascular events and arterial arteriosclerotic processes. This observational, single-centre cohort study included 240 consecutive noncardiac surgery patients aged ≥ 45 years. Simultaneous blood pressure recordings were taken preoperatively and IASBPD was calculated. Patients' electrocardiography recordings and high sensitivity cardiac troponin T (hscTnT) levels were obtained for a period of three days postoperatively. Postoperatively, 27 (11.3%) patients were found to have MINS when hscTnT ≥ 14 ng/L was taken as a cut-off value. IASBPD > 10 mm Hg was found in 44 (18.3%) patients. When IASBPD was accepted to be a continuous variable, there was a higher IASBPD value in the MINS group (9.4 ± 5.0 vs. 4.5 ± 3.8, p < 0.000). When patients were grouped as those having IASBPD > 10 mm Hg and those not, exaggerate IASBPD was found to be more frequent in patients developing MINS (16 [59.3%] vs. 28 [13.1%], respectively, p < 0.000). Multiple logistic regression analysis found IASBPD > 10 mm Hg to be independently associated with the development of MINS (OR: 30.82; CI: 9.14-103.98; p < 0.000). Receiver operating char-acteristic curve analysis showed that the optimal IASBPD cut-off value for predicting MINS was 11.5 mm Hg, with a sensitivity of 61.0% and specificity of 89.1% (AUC = 0.79; 95% CI 0.71-0.87). Increased IASBPD is closely related to development of MINS. The preoperative measurement of blood pressure from both arms may be an important and easy to use clinical tool in determining cardiovascular risk.

Inter-Arm Difference in Brachial Blood Pressure in the General Population of Koreans.

Background and ObjectivesWe investigated the inter-arm difference in blood pressure of the general Korean population to identify associated factors.Subjects and MethodsA total of 806 participants aged 30 to 64 years without history of major cardiovascular disease were analyzed in this cross-sectional study. They participated in the Cardiovascular and Metabolic Disease Etiology Research Center cohort study that began in 2013. Brachial blood pressure was measured simultaneously for both arms using an automated oscillometric device equipped with two cuffs in seated position. After five minutes of rest, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured three times. The average of the three measurements was used for analysis. Multivariate logistic regression models were used to identify factors associated with inter-arm differences in blood pressure.ResultsThe mean inter-arm difference was 3.3 mmHg for SBP and 2.0 mmHg for DBP. Large inter-arm differences (≥10 mmHg) in SBP and in DBP were found in 3.7% and 0.9% of subjects, respectively. A large inter-arm difference in SBP was associated with mean SBP (p=0.002) and C-reactive protein (p=0.014) while a large inter-arm different in DBP was only associated with body mass index (p=0.015). Sex, age, and anti-hypertensive medication use were not associated with differences in inter-arm blood pressure.ConclusionLarge inter-arm difference in blood pressure is only present in a small portion of healthy Korean adults. Our findings suggest that high SBP, chronic inflammation, and obesity may be associated with larger difference in inter-arm blood pressure.

Inter-arm difference and orthostatic changes of brachial blood pressure in the very elderly patients under antihypertensive treatment

Background. Inter-arm difference in blood pressure (BP) and orthostatic BP response are significant prognostic factors in hypertensive patients, especially in the elderly ones. However, data on their prevalence, predictors and clinical associations remain contradictory. The aim of our study was to investigate inter-arm difference and orthostatic response and to establish their clinical associations in the very elderly hypertensive patients. Design and methods. We enrolled 67 hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5 % male, mean clinic brachial systolic BP (SBP) 134,8 ± 23,2 mm Hg) in a cross-sectional study. Simultaneous bilateral brachial BP measurements were performed using oscillometric validated cuffbased device in sitting position and then 2 minutes after standing up. Central pulse waveform characteristics and arterial stiffness parameters were estimated by BPLab Vasotens system (Petr Telegin, Russia). Results. The median of inter-arm difference in SBP (IADSBP) was 4,00 (2,50, 9,00) mm Hg. IADSBP was ≥ 10 mm Hg in 25,4 % participants. Compared to others, those with IADSBP ≥ 10 mmHg had significantly higher body mass index (31,39 ± 5,73 vs 28,48 ± 4,1 kg/m2 , p < 0,05), waist circumference (116,3 ± 13,6 vs 107,7 ± 11,2 cm, p < 0,05) and pulse wave velocity in aorta (11,65 ± 1,46 vs 10,75 ± 1,71 m/s, p < 0,05). A positive correlation between IADSBP and augmentation index was revealed (r = 0,277, p < 0,05). Patients with asymptomatic orthostatic hypotension (22,4 % participants) had higher levels of brachial SBP and pulse pressure while central BP and markers of arterial stiffness did not differ from those without orthostatic hypotension. Conclusions. Significant IADSBP is associated with increased arterial stiffness and abdominal obesity in the very elderly hypertensive patients, whereas there is no evidence of interrelation between orthostatic response and arterial stiffness in these patients.

Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index

Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.

Interarm differences in systolic blood pressure and the risk of dementia and subclinical brain injury

IntroductionThis study examined whether interarm differences in systolic blood pressure (IDSBP) ≥10 mm Hg were associated with the risk of incident dementia and subclinical brain injury. MethodsBetween 1992 and 1998, 2063 participants of the Framingham Heart Study underwent assessment of IDSBP with results related to the 10-year risk of incident dementia including clinically characterized Alzheimer's disease. Secondary outcomes included markers of subclinical brain injury on magnetic resonance imaging. ResultsHigh IDSBP were associated with a greater risk of incident dementia (hazard ratio [HR] 1.92; 95% confidence interval [CI], 1.09–3.40) and Alzheimer's disease (HR, 2.32; 95% CI, 1.29–4.18), but only in those who carried an apolipoprotein E (APOE) ε4 allele. IDSBP also predicted lower total brain volumes and more prevalent silent brain infarcts in those who were APOE ε4 positive. DiscussionHigh IDSBP were associated with an increased risk of dementia, including clinical Alzheimer's disease, and subclinical brain injury in those who were APOE ε4 positive.

The Relationship Between the Metabolic Syndrome and Systolic Inter-Arm Systolic Blood Pressure Difference in Korean Adults.

The present study was conducted to assess the relationship between metabolic syndrome and systolic inter-arm blood pressure difference (sIAD) in Korean adults. This study included 410 adults (235 males, 175 females) who were over 30 years old and had undergone a health check from July to December in 2013. The incidence of high sIAD and metabolic syndrome were 23.4% and 23.2%, respectively. Key study results were as follows: First, the sIAD levels increased significantly with an increase in metabolic syndrome score (p<0.001), shown by sIAD levels after adjusted the variables that affect sIAD levels (age, gender, smoking, drinking, exercising, total cholesterol, and body mass index). These were 4.6±0.7 mmHg for metabolic syndrome score (MSS) 0; 5.8±0.5 mmHg for MSS 1; 6.2±0.6 mmHg for MSS 2, 9.2±0.8 mmHg for MSS 3; and 9.9±1.2 mmHg for MSS ≥4 (p<0.001). Second, the sIAD level of the metabolic syndrome group (9.3±0.7 mmHg) was significantly higher (p<0.001) than for the nonmetabolic syndrome group (5.7±0.3 mmHg). In conclusion, metabolic syndrome and an increased number of its components are associated with the sIAD levels in Korean adults.

Prevalence of simultaneously measured interarm systolic blood pressure difference and its clinical and demographic predictors: a systemic review and meta-analysis.

Prevalence of interarm systolic blood pressure difference and clinical and demographic characteristics associated with interarm systolic blood pressure difference (IASBPD) have been a matter of debate. We aimed to ascertain the prevalence of IASBPD and clinical and demographic characteristics associated with it. We searched PubMed, EMBASE, and CINAHL, Ovid and Cochrane Library, and Google Scholar. Twenty-seven studies meeting all inclusion criteria were included in the analysis. Weighted average cumulative prevalence of simultaneous IASBPD of 10, 15, and 20 mmHg or greater was 9.49% [95% confidence interval (CI) 7.9-11.1%], 5.3% (95% CI 3.1-7.5%), and 4.4% (95% CI 1.5-7.4%), respectively. The prevalence of IASBPD of 10 mmHg was 9% (95% CI 7-11%), 7.5% (95% CI 5.6-9.4%), and 12.1% (95% CI 8.2-16.1%) in outpatient, community, and hospital-based setting, respectively. The prevalence of IASBPD of 15 mmHg was 4.9% (95% CI 2.7-7.2%) in outpatient and 8% in hospital setting. The prevalence of IASBPD of 20 mmHg was 4.4% (95% CI 2.8-11.6%) in outpatient and 4.4% (95% CI 2.1-6.8%) for the hospital setting. Pairwise meta-analysis of five studies showed that the presence or absence of IASBP was not associated with age, sex, diabetes, hypertension, dyslipidemia, and smoking history. However, participants with IASBPD of 10 mmHg or greater had a higher BMI compared with those with IASBPD of less than 10 mmHg. After BMI, hypertension and dyslipidemia had strongest association with IASBPD, but results were not statistically significant. IASBPD is relatively prevalent, but prevalence is lower than that previously reported. Prevalence is higher when blood pressure is measured in hospital setting compared with outpatient and community setting.

Interarm Blood Pressure Difference in Patients With Systemic Lupus Erythematosus.

This study was performed to determine the relationship between systemic lupus erythematosus (SLE) and the interarm blood pressure difference (IAD) and to elucidate the role of the IAD as a surrogate marker for early detection of peripheral artery disease (PAD) in patients with SLE. In total, 135 patients with SLE and 135 age- and gender-matched subjects were enrolled. The IAD and risk of an abnormal IAD were compared between the SLE and control groups, and logistic regression analysis was performed to determine the relationship between SLE and an abnormal IAD. The specificity and sensitivity of an IAD of 10 mm Hg or greater for diagnosis of PAD (ankle brachial index of <0.90) were calculated. Both the systolic and diastolic IADs were significantly higher in the SLE group than in the control group (P < 0.001). After adjustment for confounding factors, SLE remained significantly associated with an abnormal IAD (P = 0.039). Both the systolic and diastolic IADs were negatively associated with the ankle brachial index. Using a systolic IAD of 10 mm Hg or greater as the cutoff point, the specificity and sensitivity for PAD were 90% and 41%, respectively. A diastolic IAD of 10 mm Hg or greater exhibited higher specificity (92%), but lower sensitivity (30%). Systemic lupus erythematosus is independently associated with an abnormal IAD, and an IAD of 10 mm Hg or greater predicts PAD with high specificity but low sensitivity. Blood pressure should be measured at least once in both arms in patients with SLE for early detection of asymptomatic PAD.

Inter-arm systolic blood pressure difference is a useful predictor for clinical outcome

Inter-arm systolic blood pressure difference is a useful predictor for clinical outcome

Inter-Arm Blood Pressure Difference in Hospitalized Elderly Patients Is Not Associated With Excess Mortality.

Inter-arm blood pressure difference (IAD) has been found to be associated with cardiovascular mortality. Its clinical significance and association with mortality in the elderly is not well defined. This study evaluated the association of IAD with mortality in a cohort of hospitalized elderly individuals. Blood pressure (BP) was measured simultaneously in both arms in elderly individuals (older than 65 years) hospitalized in a geriatric ward from October 2012 to July 2014. During the study period, 445 patients, mostly women (54.8%) with a mean age of 85±5 years, were recruited. Systolic and diastolic IAD were >10 mm Hg in 102 (22.9%) and 76 (17.1%) patients, respectively. Patients were followed for an average of 342±201 days. During follow-up, 102 patients (22.9%) died. Mortality was not associated with systolic or diastolic IAD. It is therefore questionable whether BP should be routinely measured in both arms in the elderly.

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

ObjectiveTo evaluate whether an association exists between an inter-arm systolic blood pressure difference (sIAD) and all-cause and cardiovascular mortality. MethodsWe searched for cohort studies that evaluated the association of a sIAD and all-cause or cardiovascular mortality in the electronic databases Medline/PubMed and Embase (August 2014). Random effects models were used to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsNine cohort studies (4 prospective and 5 retrospective) enrolling 15,617 participants were included. The pooled HR of all-cause mortality for a sIAD of ≥10mmHg was 1.53 (95% CI 1.14–2.06), and that for a sIAD of ≥15mmHg was 1.46 (1.13–1.88). Pooled HRs of cardiovascular mortality were 2.21 (95% CI 1.52–3.21) for a sIAD of ≥10mmHg, and 1.89 (1.32–2.69) for a sIAD of ≥15mmHg. In the patient-based cohorts including hospital- and diabetes-based cohorts, both sIADs of ≥10 and ≥15mmHg were associated with increased all-cause (pooled HR 1.95, 95% CI 1.01–3.78 and 1.59, 1.06–2.38, respectively) and cardiovascular mortality (pooled HR 2.98, 95% CI 1.88–4.72 and 2.10, 1.07–4.13, respectively). In the community-based cohorts, however, only a sIAD of ≥15mmHg was associated with increased cardiovascular mortality (pooled HR 1.94, 95 % CI 1.12–3.35). ConclusionsIn the patient populations, a sIAD of ≥10 or of ≥15mmHg could be a useful indictor for increased all-cause and cardiovascular mortality, and a sIAD of ≥15mmHg might help to predict increased cardiovascular mortality in the community populations.

Abstract P180: Ten-Year and Lifetime Cardiovascular Risk and Subclinical Cardiovascular Disease in Mexican Women

Introduction: Estimates of Lifetime Cardiovascular Risk may identify individuals with different levels of cardiovascular disease (CVD) risk within the low short-term risk (10-year risk) for coronary heart disease (CHD) category defined by the Framingham Risk Score. Evidence of the applicability of this risk stratification in relatively young people is limited, especially among Hispanics. Hypothesis: We assessed the hypothesis that the risk categories from the combination of these two risk stratification scales are positively associated with subclinical CVD in Mexican women. Methods: We calculated 10-year CHD risk using the Framingham Risk Score and lifetime CVD risk based on risk factor burden in 759 women in Southern Mexico from the Mexican Teachers’ Cohort and evaluated the presence of subclinical CVD. We evaluated common carotid intima-media thickness (IMT), ankle-brachial index (ABI), and inter-arm blood pressure difference (IAD) using standard protocols and performed laboratory analyses from a fasting blood draw. We defined three risk strata: Low 10-year (&lt;10%)/Low lifetime risk, Low 10-year (&lt;10%)/High lifetime risk, and High 10-year risk (≥10%). We evaluated outcome measures continuously and estimated the prevalence of subclinical CVD for each risk strata. We defined subclinical CVD as IMT ≥0.8 mm or atheromatous plaque, ABI &lt;0.90, systolic IAD ≥20 mmHg or diastolic IAD ≥10 mmHg. We calculated the sensibility and specificity of the predicted risk categories to detect subclinical CVD. Results: Women evaluated had a mean age of 48.4 years, 22.5% (n=171) were classified as High 10-year CHD Risk, 58.8% (n=446) as Low 10-year/High lifetime risk and 18.7% (n=142) as Low 10-year/Low lifetime risk. We observed significant increase in IMT measurement according to increasing risk categories: 0.656 mm (±0.062), 0.704mm (±0.085), and 0.739mm (±0.089) (p= &lt;0.001). We found similar significant trends in ABI (p= 0.001), systolic IAD (p= &lt;0.001), and diastolic IAD (p= &lt;0.001). We observed a significant higher prevalence of at least one subclinical CVD as the risk category increased: 10.6%, 26.9%, and 45.6% (p= &lt;0.001). The sensitivity and specificity of the combination of these scores to detect subclinical CVD was of 93% and 23%, whereas only considering the high vs. low 10-year risk categories these parameters were 37% and 83% respectively. Conclusion: The combination of these short-term and lifetime risk scores accurately identify differences in objective measurements of subclinical cardiovascular disease in Mexican women. Further calibration of these risk scores is needed to incorporate them in the risk assessment tools to identify individuals at risk for the implementation of preventive strategies in the Mexican population.

Interarm systolic blood pressure as a predictor of cardiovascular events in patients with chronic kidney disease.

Increased interarm systolic blood pressure difference (IASBPD) is associated with mortality and cardiovascular (CV) events both in the general population and in patients at high CV risk. The aim of the present study was to assess the value of IASBPD ≥ 10 mmHg for predicting CV events in patients with chronic kidney disease (CKD). The study sample comprised 652 patients with CKD (age 67 ± 15 years, 58.1% men). Follow-up was 19 ± 5 months. We recorded increased IASBPD and related factors and assessed the predictive value of this variable for CV events. We recorded diabetes mellitus in 136 patients (20.8%), history of CV disease in 213 (32.6%) and dyslipidaemia in 327 (50.1%). The mean glomerular filtration rate was 45.9 ± 18.9 mL/min/1.73 m(2), and the median albumin/creatinine ratio was 26(0-151) mg/g. IASBPD was ≥10 mmHg in 184 patients (28.1%). The factors associated with IASBPD ≥10 mmHg were age, systolic blood pressure levels, history of congestive heart failure, lower levels of high-density lipid cholesterol and higher use of hypertensive drugs. Fifty-eight patients (8.5%) developed a CV event during the follow-up. IASBPD ≥10 mmHg [HR, 1.802, 95%CI (1.054-3.079); P = 0.031] was an independent predictor of CV events. Increased IASBPD is an independent predictor of CV events in CKD patients.

Role of PET/CT in the diagnosis of large vessel vasculitis in a patient with systemic inflammatory response syndrome

A 57-year-old woman presented with systemic inflammatory response syndrome manifesting as high-grade fever over the past 2 months, unexplained fatigue, malaise, weight loss, night sweats, diffuse nonspecific arthralgias and myalgias. The patient had a history of hypertension for 2 years. The physical examination, with a focus on pulse assessment, bruit auscultation, and inter-arm systolic blood pressure difference, was not suggestive of arterial disease. Laboratory results showed leukocytosis (12,100/μL), elevated erythrocyte sedimentation rate (72 mm/h), and C-reactive protein level (131 mg/L). No clear focus of infection was found. A transthoracic echocardiogram was negative for infective endocarditis. Contrast-enhanced computed tomography of the chest, abdomen, and pelvis did not reveal clinically important abnormalities. With a suspicion of an occult malignancy, the patient underwent whole-body fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) that showed increased 18F-FDG uptake in the thoracic and abdominal aorta expanding to the subclavian, common carotid, and femoral arteries (Figure 1). In the setting of systemic inflammatory response syndrome, we judged these images to be compatible with large vessel vasculitis (LVV). The patient initiated treatment with methylprednisolone and methotrexate, resulting in significant improvement of symptoms and reduction of inflammatory markers.

Inter-arm blood pressure difference in hospitalized elderly patients--is it consistent?

Inter-arm blood pressure difference (IAD) is recognized as a risk factor for cardiovascular mortality. Its reproducibility in the elderly is unknown. The authors determined the prevalence and reproducibility of IAD in hospitalized elderly patients. Blood pressure was measured simultaneously in both arms on two different days in elderly individuals hospitalized in a geriatric ward. The study included 364 elderly patients (mean age, 85±5years). Eighty-four patients (23%) had systolic IAD >10 and 62 patients (17%) had diastolic IAD >10mmHg. A total of 319 patients had two blood pressure measurements. Systolic and diastolic IAD remained in the same category in 203 (64%) and 231 (72%) patients, respectively. Correlations of systolic and diastolic IAD between the two measurements were poor. Consistency was not affected by age, body mass index, comorbidities, or treatment. IAD is extremely common in hospitalized elderly patients, but, because of poor consistency, its clinical significance in this population is uncertain.

Increased ventricular wall stress and late gadolinium enhancement in Takotsubo cardiomyopathy

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Association of Bilateral Brachial-Ankle Pulse Wave Velocity Difference with Peripheral Vascular Disease and Left Ventricular Mass Index

Unequal arterial stiffness had been associated with cardiovascular risks. We investigated whether an association existed between unequal arterial stiffness indicated by bilateral brachial-ankle pulse wave velocity (baPWV) difference and ankle-brachial index (ABI), baPWV, echocardiographic parameters and interarm and interankle systolic blood pressure (BP) differences. A total of 1111 patients referred for echocardiographic examination were included in this study. The BPs, ABI and baPWV were measured simultaneously by an ABI-form device. The ΔbaPWV was defined as absolute value of difference between bilateral baPWV. We performed three multivariate analyses for determining the factors associated with a ΔbaPWV ≧ 185 cm/s (90 percentile of ΔbaPWV) (model 1: significant variables in univariate analysis and ABI <0.9 and baPWV; model 2: significant variables in univariate analysis and left ventricular mass index [LVMI]; model 3: significant variables in univariate analysis and interankle systolic BP difference ≧ 15 mmHg). The ABI <0.9 and high baPWV (both P<0.001) in model 1, high LVMI (P = 0.021) in model 2 and an interankle systolic BP difference ≧ 15 mmHg (P = 0.026) in model 3 were associated with a ΔbaPWV ≧ 185 cm/s, but the interarm systolic BP difference ≧ 10 mmHg was not (P = NS). Our study demonstrated ABI <0.9, high baPWV, high LVMI and an interankle systolic BP difference ≧ 15 mmHg were associated with unequal arterial stiffness.