Inter-arm Systolic Blood Pressure Research Articles

Evaluation of the inter-arm blood pressure difference in subjects with hypertension in Nnewi North Local Government Area, Anambra state

Hypertension is defined as a sustained elevated blood pressure with a systolic blood pressure (SBP) of 140mmHg or more and a diastolic blood pressure of 90mmHg or more. The evaluation of the inter-arm blood pressure difference in subjects with hypertension in Nnewi North Local Government Area, Anambra state was done via sampling techniques. The study population was obtained using convenience sampling method and comprised of male and female hypertensive patients aged 25 to 90 years, from the cardiology unit NAUTH Nnewi. Normotensive subjects of the same age range and gender were used as control. The sample size was determined to be 70 subjects using this formula: n= (z2pq)/d2). The result of the finding showed that there was a significant increase in the mean age when the control was compared to the hypertensive group, and no significant difference in their weight, height and BMI. Furthermore, the findings of this research also supported a significant increase in the left arterial systolic and diastolic blood pressure in the control compared to the hypertensive groups. Also, the mean right systolic and diastolic blood pressure showed a significant increase when the control was compared to the hypertensive group. The inter-arm systolic and diastolic blood pressure had no significant difference when control was compared to the hypertensive group.

Association of interarm blood pressure difference with selected body circumferences among Walter Sisulu University community

BackgroundA high interarm blood pressure difference (IAD) has been identified as a precursor of vascular diseases. Anthropometric measures for obesity such as body circumferences including waist circumference (WC), mid-upper arm circumference (MUAC) and neck circumference (NC) have been associated with a high IAD in Western countries. However, the prevalence of IAD and its association with body circumferences in South African communities such as universities is not well established. Therefore, this study aimed at investigating the correlation of IAD with selected body circumferences among the Walter Sisulu University (WSU) community.MethodsA total of 230 participants, 117 males and 113 females, consisting of 185 students and 45 staff members from WSU, aged 18–27 and 18–63 years respectively, participated in this cross-sectional study. The selected body circumferences: WC, MUAC, and NC were measured using standard procedures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in both arms simultaneously using automated machines. IAD was achieved by calculating differences in SBP and DBP between the left (L) and right (R) arms, (R -L), and getting the absolute value, L–R (|L–R|).Results14.78% of the participants had an interarm SBP difference (IASBPD) ≥ 10 mmHg, and 4.35% of participants had an interarm DBP difference (IADBPD) ≥ 10 mmHg.In a Pearson’s correlation analysis, IASBPD was positively correlated with the selected body circumferences (WC, r = 0.29; P < 0.001; MUAC, r = 0.35; P < 0.001; NC, r = 0.27; P < 0.001) and mean arterial pressure (MAP) (r = 0.30; P < 0.001). In the multivariable-adjusted regression analyses, IASBPD was positively associated with MUAC (adjusted R2 = 0.128, β = 0.271 (95% CI = 0.09; 0.60), P = 0.008), and NC (adjusted R2 = 0.119, β = 0.190 (95% CI = 0.01; 0.32), P = 0.032) only, adjusted for MAP, age, gender, body mass index, smoking, and alcohol. There was no association of body circumferences with IADBPD.ConclusionA high IAD is common among students and staff members of the WSU community. Furthermore, IAD showed a positive correlation with MUAC and NC. These body circumferences can serve as indicators of high IAD, aiding in the early detection and prevention of vascular diseases.

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

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

Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult’s Cohort Study (FACS)

BackgroundOne of the modifiable risk factors for cardiovascular diseases is the inter-arm blood pressure difference (IAD), which can be easily measured. This study aimed to determine the prevalence and factors related to the Iranian population’s inter-arm differences in systolic and diastolic blood pressure.MethodThis cross-sectional study was conducted on the baseline data of participants who had Iranian nationality, were at least 1 year of residence in the area, aged within the age range of 35–70 years, and willed to participate from the Fasa Persian Adult Cohort Study (FACS). IAD for systolic and diastolic blood pressure was measured and categorized into two groups of difference < 10 and ≥ 10 mmHg. Logistic regression was used to model the association between independent variables and IAD.ResultsThe prevalence of systolic and diastolic IAD ≥ 10 mmHg was 16.34% and 10.2%, respectively, among 10,124 participants. According to the multivariable logistic regression models, age (adjusted odds ratio (aOR): 1.019 [95% CI: 1.013, 1.025]), body mass index (BMI) (aOR: 1.112 [95% CI: 1.016, 1.229]), having type 2 diabetes (aOR Yes/No: 1.172 [95% CI: 1.015, 1.368]), having chronic headaches (aOR Yes/No: 1.182 [95% CI: 1.024, 1.365]), and pulse rate (aOR: 1.019 [95% CI: 1.014, 1.024]) significantly increased the odds of systolic IAD ≥ 10 mmHg. Additionally, high socio-economic status decreased the odds of systolic IAD ≥ 10 mmHg (aOR High/Low: 0.854 [95% CI: 0.744, 0.979]). For diastolic IAD, age (aOR: 1.112 [95% CI: 1.015, 1.210]) and pulse rate (aOR: 1.021 [95% CI: 1.015, 1.027]) significantly increased the odds of diastolic IAD ≥ 10 mmHg. Moreover, high socioeconomic status decreased the odds of diastolic IAD ≥ 10 mmHg (aOR High/Low: 0.820 [95% CI: 0.698, 0.963]).ConclusionThe noticeable prevalence of systolic and diastolic IAD in general population exhibits health implications due to its’ association with the risk of cardiovascular events. Sociodemographic and medical history assessments have potentials to be incorporated in IAD risk stratification and preventing programs.

Contributing Factors for the Increased Inter-arm Systolic Blood Pressure Difference in Different Age Groups

Abstract OBJECTIVE To explore the contributing factors for the increased inter-arm systolic blood pressure difference (IASBPD) in young, middle-aged, and elderly people. METHODS A total of 51,428 workers in Kailuan who underwent arteriosclerosis detection of extremities during physical examination from 2010 to 2020 were selected as the subjects. The subjects were divided into 3 groups according to the age segment proposed by the World Health Organization: young, middle-aged, and elderly group. Each age group was subsequently divided into 2 groups according to whether the IASBPD was increased: IASBPD 15 mm Hg and IASBPD &amp;gt;15 mm Hg group. The detection rate of IASBPD &amp;gt;15 mm Hg in each age group was calculated, and the contributing factors of IASBPD &amp;gt;15 mm Hg in different age groups were analyzed via multifactor logistic regression model. RESULTS The detection rate of IASBPD &amp;gt;15 mm Hg was 15.65% in all the subjects, and it was 12.90%, 15.28%, and 20.69% in the young, middle-aged, and elderly groups, respectively (χ2 = 343.83, P &amp;lt; 0.01). In all the young, middle-aged, and elderly groups, the risk factors for IASBPD &amp;gt;15 mm Hg included decreased ankle–brachial index (ABI), elevated body mass index (overweight and obesity), male, elevated brachial–ankle pulse wave velocity (baPWV), and hypertension. Furthermore, elevated high sensitive C-reactive protein (hsCRP) was a risk factor for increased IASBPD in young people (odds ratio [OR] = l.02, 95% confidence interval [CI] 1.00–1.04). And elevated low-density lipoprotein cholesterol (LDL-C) was a risk factor (OR = 1.09, 95% CI 1.03–1.15) for increased IASBPD in middle-aged people, and the high level of education was a protective factor (OR = 0.86, 95% CI 0.79–0.94). Diabetes (OR = 1.29, 95% CI 1.16–1.42) and old age (OR = 1.01, 95% CI 1.01–1.02) were risk factors for increased IASBPD in the elderly people, and high level of education (OR = 0.84, 95% CI 0.74–0.95) and elevated high-density lipoprotein cholesterol (HDL-C) (OR = 0.82, 95% CI 0.72–0.93) were protective factors. CONCLUSIONS The detection rate of IASBPD &amp;gt;15 mm Hg increases with the increase of age in the young, middle-aged, and elderly groups. Decreased ABI, elevated overweight obesity, male, elevated baPWV, and hypertension are common risk factors for increases IASBPD in 3 age groups. Furthermore, elevated hsCRP, elevated LDL-C, diabetes mellitus, and old age are risk factors for increased IASBPD in young, middle-aged, and elderly group, respectively.

Interarm Blood Pressure Difference in Young Healthy Adults.

Inter-arm difference in blood pressure is the difference in the systolic and the diastolic blood pressure between arms of an individual. According to American heart association, interarm Blood Pressure difference of more than 10 mm of Hg are associated with peripheral vascular disease. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of hypertension, age, sex and Body mass index is related to higher interarm difference Methods: A cross-sectional study was carried out among 270 students of Manipal College of Medical Sciences, Pokhara, Nepal. Blood pressure was measured in both the arms using a mercury sphygmomanometer. (Elko 300) Statistical analysis was done using paired t test, chi-square and Pearson's correlation test using SPSS 23. The absolute mean Inter-arm difference for systolic blood pressure was 11.03±0.67mm Hg and for diastolic blood pressure was 6.020 ±0.21 mm Hg. There is significant inter-arm difference for systolic blood pressure and diastolic blood pressure (p<0.001). Inter-arm systolic blood pressure difference was significantly associated with family history of hypertension, age and Body Mass Index (p<0.001) Meanwhile, there was no statistically significant association of sex, family history of hypertension, age and Body Mass Index with inter-arm difference for diastolic blood pressure. Significant inter-arm systolic and diastolic blood pressure differences was found in the young, healthy population. Positive correlation of increased Inter-arm difference in Blood Pressure with family history of hypertension was confirmed. This emphasizes the importance of measuring blood pressure in both arms to be a routine practice as we aim for early diagnosis and prompt treatment of hypertensive disorders.

Association between inter-arm blood pressure difference and cardiovascular disease: result from baseline Fasa Adults Cohort Study

The inter-arm blood pressure difference has been advocated to be associated with cardiovascular mortality and morbidity. Our study aimed to investigate the association between Inter-arm systolic and diastolic blood pressure differences and Cardio Vascular Disease (CVD). A total of 10,126 participants aged 35–70 years old were enrolled in a prospective Fasa Persian Adult Cohort. In this cross-sectional study, the cutoff values for inter-arm blood pressure difference were less than 5, greater than 5, greater than 10, and greater than 15 mm Hg. Descriptive statistics and logistic regression were used to analyze the data. Based on the results the prevalence of ≥ 15 mmHg inter-arm systolic and diastole blood pressure difference (inter-arm SBPD and inter-arm DBPD) were 8.08% and 2.61%. The results of logistic regression analysis showed that inter-arm SBPD ≥ 15 and (OR<5/≥15 = 1.412; 95%CI = 1.099–1.814) and inter-arm DBPD ≥ 10 (OR<5/≥10 = 1.518; 95%CI = 1.238–1.862) affected the risk of CVD. The results showed that the differences in BP between the arms had a strong positive relationship with CVD. Therefore, inter-arm blood pressure could be considered a marker for the prevention and diagnosis of CVD for physicians.

ABNORMAL INTER-ARM SYATOLIC BLOOD PRESSURE DIFFERENCE IN ADULTS WITH CONGENITAL HEART DISEASE

Objective: Many papers have been reported that hypertension and cardiovascular disease are high frequency in adults with congenital heart disease. It is well known that significant inter-arm blood pressure difference can predict cardiovascular risk. We investigate the inter-arm blood pressure difference in adults with congenital heart disease. Design and method: We enrolled 100 consecutive subjects aged 20 years or more, who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were history of arrhythmia, which makes accurate pulse wave analysis impossible and history of cardiac operation within 6 months. The patients were classified into 3 groups. The patients in group A had undergone surgery, which sacrifice subclavian arteries (subclavian flap method and original Blalock-Taussig shunt). The patients in group B had undergone surgery to their subclavian arteries, which conserve their subclavian arteries (modified Blalock- Taussig shunt). The patients in group C had not undergone surgery to their subclavian arteries. The bilateral brachial blood pressures were simultaneously measured using form PWV/ABI (Colin, Komaki, Japan). The inter-arm systolic blood pressure difference greater than 10mmHg was defined as significant inter-arm systolic blood pressure difference. Results: Patients’ age was 36.6±14.9 years. Mean difference between bilateral brachial systolic blood pressures was 8.2±13.6 mmHg. Twenty-one patients demonstrated the inter-arm systolic blood pressure difference (29%). Nine patients were classified as group A and all patients in group A demonstrated inter-arm systolic blood pressure difference (29.1±35.6mmHg). Sixteen patients were classified as group B and 9 patients had undergone modified Blalock-Taussig shunt bilaterally. Four patients (44%) in group B demonstrated inter-arm systolic blood pressure difference (bilateral; 3, unilateral: 1). In 75 group C patients, 8 patients (11%) demonstrated inter-arm systolic blood pressure difference. There was no difference between group C patients in with and without the inter-arm systolic blood pressure difference in body mass index, hemoglobin A1 level, lipid profile. Conclusions: The significant inter-arm systolic blood pressure difference in adults with congenital heart disease is not uncommon. The intervention can strongly influence on their inter-arm systolic blood pressure difference.

The predictive value of interarm systolic blood pressure differences in patients with vascular disease: Sub-analysis of the COMPASS trial

Background and aimsSystolic blood pressure interarm difference (IAD) predicts cardiovascular morbidity and mortality in primary prevention populations. We examined the predictive value of IAD and the effects of treatment with the combination of rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily versus aspirin 100 mg once daily according to IAD in patients with chronic coronary artery disease or peripheral artery disease. MethodsCOMPASS trial patients with IAD <15 mmHg and IAD >15 mmHg were compared with respect to thirty-month incidence risk of: 1) composite of stroke, myocardial infarction, or cardiovascular death (MACE), 2) composite of acute limb-ischemia or vascular amputation (MALE), 3) composite of MACE or MALE, and 4) effects of treatment with the combination versus aspirin alone on these outcomes. Results24,539 patients had IAD<15 mmHg and 2,776 had IAD ≥15 mmHg. Relative to patients with IAD ≥15 mm Hg, those with IAD<15 mmHg had similar incidence rates for all measured outcomes including the composite of MACE or MALE (HR 1.12 [95% CI: 0.95 to 1.31], p = 0.19), with the exception of stroke (HR 1.38 [95% CI: 1.02 to 1.88], p = 0.04). Compared to aspirin alone, the combination consistently reduced the composite of MACE or MALE in both IAD <15 mmHg (HR 0.74 [95% CI: 0.65–0.85], p < 0.0001, ARR = −23.1) and IAD>15 mmHg (HR 0.65 [95% CI: 0.44–0.96], p = 0.03; ARR = −32.6, p interaction = 0.53) groups. ConclusionsUnlike primary prevention populations, measuring IAD for risk stratification purposes does not appear to be useful in patients with established vascular disease.

PS-C11-11: DEGREE OF BRACHIAL AND CENTRAL ARTERIAL BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH INTER-ARM BLOOD PRESSURE DIFFERENCE(IAD)&lt; 10MMHG VERSUS≧ 10MMHG

RuFei Liu, WenLi Cheng(Email:chengwenli2000@163.com) Objective: IAD ≧ 10mmHg has been proven to be a predictor of cardiovascular morbidity and mortality, especially in people with hypertension. Compared with brachial blood pressure, central blood pressure was more effective in reflecting hemodynamic changes and had a stronger relationship with target organ damage. No study has analyzed the degree of central blood pressure in hypertensive patients with IAD &lt; 10mmHg versus ≧ 10mmHg. The objective of this study was to analyze differences in central and brachial arterial blood pressure and the proportion of brachial systolic blood pressure ≧ 140mmHg or central systolic blood pressure ≧ 130mmHg in hypertensive patients grouped by IAD. Methods: The study cohort comprised of 2103 eligible individuals. Their BPs were assessed simultaneously in both arms using an Omron BP-203RPEIII vascular profiler, and the IAD was measured as the absolute difference in these values (absolute value of left minus right). The CBP was noninvasively measured using an Omron HEM-9000AI device. Multivariate regression analysis was used to assess the association between the central SBP (cSBP) and the inter-arm systolic blood pressure difference (IASBPD). Results: Applying 130/140 mmHg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (n = 1131;53.8%) and hypertension (n = 702;33.4%) versus isolated brachial hypertension (n = 178;8.5%) and isolated central hypertension (n = 92;4.4%). Women made up close to 70% of the patient with central systolic hypertension but normal bSBP. After adjusting for brachial SBP, brachial DBP, sex, age and BMI, patients with IAD ≧ 10mmHg had a higher risk of cSBP ≧ 130mmHg [OR (95%CI): 1.6 (1.3, 2.1), P &lt; 0.001]. Conclusion: Hypertensive patients with IAD *&amp;ge* 10mmHg had higher cSBP, cDBP and a higher proportion of central systolic blood pressure.

PS-C04-5: ASSOCIATIONS BETWEEN INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND HYPERTENSIVE ORGAN DAMAGES IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Several studies and meta-analyses have reported that interarm systolic blood pressure difference (IAD) in the upper limbs is associated with risks such as all-cause mortality and cardiovascular diseases. However, few results have examined the usefulness of IAD as an index of arteriosclerosis in patients with essential hypertension (EHT). We investigated the relationship between IAD and vascular structures and evaluated the usefulness of IAD as an index of hypertensive organ damages in EHT patients. Design and method: In 71 untreated EHT patients (48 males, average age 56 ± 13 years) without chronic kidney disease (urinary albumin excretion less than 300 mg / g of creatinine and estimated glomerular filtration rate 60 mL / min / 1.73m2 or more), blood sampling, 24-hour urine collection, and 24-hour blood pressure monitoring were performed. Next, as cardiovascular structural indices, Next, as indicators of vascular structure, the intima media thickness of carotid artery (IMT) was measured by ultrasonography, and the cardio ankle vascular index (CAVI) and ankle brachial index (ABI) were measured by using the Vascular Screening System VaSera VS-1000 (Fukuda Denshi, Tokyo, Japan) device. The absolute value of the difference between the left and right blood pressure measured at the same time was defined as IAD. Results: IAD was not associated with age, BMI, or systolic and diastolic blood pressure in 24-hour blood pressure monitoring. IAD increased accompanying with a decrease in creatinine clearance (r = -0.25, p &lt; 0.05). IAD correlated positively with IMT (r = 0.24, p &lt; 0.05) and negatively with ABI (r = -0.45, p &lt; 0.01), whereas it did not associate with CAVI. Furthermore, in multiple regression analysis using any of IMT, ABI and creatinine clearance as objective variables, and conventional risk factors for atherosclerosis and IAD as explanatory variables, IAD became an independent determinant factor for IMT, ABI and creatinine clearance. Conclusions: In EHT patients, IAD was associated with decreased renal function and vascular abnormalities. IAD was considered to be a useful index as an initial screening for latent hypertensive organ damages in EHT patients.

PS-C05-9: COMBINED EFFECT OF INTER-ARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND CAROTID ARTERY PLAQUE ON CARDIOVASCULAR EVENTS

Objectives: Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD) respectively. But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality. Methods: We enrolled 4970 participants (≧ 40 years old) in the prospective Kailuan Study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque, Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality. Results: During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≧ 10mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI) and myocardial infarction (10%, 7.27%, 1.36%, respectively). After adjusting for covariates, the IASBPD ≧ 10mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59). Conclusions: Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.

Combined effect of inter-arm systolic blood pressure difference and carotid artery plaque on cardiovascular diseases and mortality: A prospective cohort study

Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD). But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality. We enrolled 4,970 participants (≥40 years old) in the prospective Kailuan study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque and Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality. During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≥ 10 mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI), and myocardial infarction (10, 7.27, and 1.36%, respectively). After adjusting for covariates, the IASBPD ≥ 10 mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59). Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.

A Cross-Sectional Study on Inter-Arm Blood Pressure Difference among Healthy Young Adults

Introduction: The inter arm difference of blood pressure is the alteration in DBP and SBP between individuals’ both arms. IAD researches have been conducted in the pregnant women, elderly and subjects with DM and cardiovascular disease, but the number of studies in healthy young adults is very limited. Aim: Therefore, this analysis intended to assess the inter-arm difference in blood pressure in healthy young adults and its relation with gender, age, family history of hypertension and BMI. Study Design: A cross-sectional study. Place and Duration: In the Physiology Department of Saidu Group of Teaching Hospital Swat and Medicine department of MTI LRH, Peshawar for duration from October 2021 to March 2022. Methods: This study was held among 150 individuals. A mercury sphygmomanometer was used for measuring blood pressure. Statistical analysis was performed by means of the chi-square, paired t and SPSS 21.0 test and the Pearson correlation test. Results: The IAD absolute mean for systolic blood pressure was 6.02 ± 4.10 mm Hg, and 3.90 ± 2.79 mm Hg for DBP. There is a substantial IAD for SBP (t = 4.701, p &lt;0.001), but no variance DBP. The IAD in SBP was suggestively related to patient’s arterial hypertension and with their family history (χ2 = 6.50, p = 0.01) but insignificantly related to age (r = +0.140, p = 0.05). The inter-arm systolic blood pressure has no substantial variance with respect to BMI and gender. Meanwhile, no statistically substantial association between gender, age, family history of hypertension, BMI, and interarm DBP. Conclusions: There is a substantial inter-arm difference in SBP amongst healthy young adult and related with age and positive hypertension family history. Keywords: Young adults, Inter-arm difference and Blood pressure.

Characteristics of four-limb blood pressure and brachial-ankle pulse wave velocity in Chinese patients with Takayasu arteritis

Purpose: Takayasu arteritis (TA) is a rare disease, which is frequently misdiagnosed or its diagnosis can be missed. This study aimed to analyse the characteristics of four-limb blood pressure (4LBP) and brachial-ankle pulse wave velocity (baPWV) in patients with TA, which could be useful in disease detection. Materials and Methods: We consecutively enrolled 182 patients with TA at Fuwai Hospital between January 2013 and January 2016. Pulse pressure (PP), pulsatile index (PI), inter-arm systolic blood pressure (SBP) difference (IASBPD), inter-leg SBP difference (ILSBPD), ankle–brachial index (ABI), baPWV, and inter-side baPWV difference (ΔbaPWV) were analysed and compared with those of age-, sex-, and SBP-matched participants without cardiovascular diseases. Results: In the TA group, the diastolic blood pressure was lower (67.4 ± 23.7 vs 84.1 ± 15.0 mmHg), PP was larger (69.7 ± 23.6 vs 53.7 ± 10.6 mmHg), PI was higher (1.3 ± 2.1 vs. 0.6 ± 0.1 mmHg), IASBPD was larger (18.2 ± 24.1 vs 4.2 ± 3.3 mmHg), and ILSBPD was larger (10.7 ± 15.0 vs 5.3 ± 4.1 mmHg) than those of the controls (all p < 0.01). Moreover, the proportions of PP >70 mmHg (36.8% vs 4.4%), PI > 1.0 (40.1% vs 2.2%), IASBPD >15 mmHg (34.6% vs. 0%), highest ABI >1.4 (17.6% vs. 0%), ILSBPD >15 mmHg (14.8% vs. 3.3%), lowest ABI < 0.9 (24.7% vs 2.2%), and ΔbaPWV > 185 cm/s (28.6% vs. 1.1%) were significantly greater in the TA group than in the control group (all p < 0.01). Approximately 80.8% of patients with TA (vs. 10.4% of controls) presented with at least one of these seven parameters (p = 0.000). Conclusion: The characteristics of 4LBP and baPWV in most patients with TA were abnormal, which helped us perform non-invasive primary screening and comprehensive evaluation of vascular lesions in such patients.

Arterial stiffness and contralateral differences in blood pressure: The Atherosclerosis Risk in Communities (ARIC) study.

A large interarm difference in brachial systolic blood pressure (SBP) (≥10 or ≥15 mmHg) is strongly associated with elevated cardiovascular events and mortality. Evidence demonstrating whether such contralateral differences in SBP occur in ankle blood pressure and its association with arterial stiffness is scarce. The aims of this study were to characterize arm and ankle contralateral SBP differences in a sample of community‐dwelling older adults (5077), and to determine whether this difference is associated with arterial stiffness assessed by pulse wave velocity (PWV) between the heart and ankle (haPWV), femoral artery and ankle (faPWV), and brachial artery and ankle (baPWV) in the right and left sides. Prevalence of interarm SBP differences ≥10 and ≥15 mmHg was 5.1% and .7%, respectively; the corresponding prevalence for interankle SBP was 24.9% and 12.0%. Higher BMI and lower ankle‐brachial index (ABI) were significantly correlated with greater interarm SBP differences. Increased age, higher BMI, lower ABI, and greater contralateral differences in haPWV, faPWV, and baPWV were significantly correlated to greater interankle SBP differences. Interankle SBP difference ≥15 mmHg was significantly associated with contralateral differences of >80 cm/s in haPWV (OR = 1.94 [95% CI = 1.52–2.49]), >165 cm/s in faPWV (OR = 1.64 [95% CI = 1.27–2.12]), and >240 cm/s in baPWV (OR = 2.43 [95% CI = 1.94–3.05]). The associations remained significant after adjustment for age, sex, race, BMI, smoking status, and ABI. Compared with interarm differences, interankle differences in SBP are common in older adults. The magnitude of interankle, but not interarm, differences in SBP is associated with various measures of arterial stiffness.

Inter-arm differences in regional arterial stiffness and geometry lead to inter-arm systolic blood pressure differences: A modelling study

An inter-arm systolic blood pressure difference (ISBPD), if substantial in magnitude (typically defined as ≥10 mmHg), is a potential cardiovascular risk factor in adults, due to its association with cardiovascular events/mortality. A substantial ISBPD occurs in approximately 10% of the adult population, and, although associations with vascular disease and elevated stiffness have been reported, the mechanisms underlying ISBPD remain unknown. The aim of this study was to investigate whether inter-arm differences in segmental pulse wave velocity, cross-sectional area, or vascular bed compliance/resistance could give rise to substantial differences in brachial pressures between arms; for example, due to differences in pulse wave transmission and reflection. Using an established one-dimensional model of the major systemic arteries, pulse wave velocity (PWV) was uniformly increased or decreased in arteries of 1) the supra-aortic region leading up to the arm, 2) the brachial region, 3) the forearm, and 4) all of these (entire arm pathway); for the left arm, right arm, and both arms. Cross-sectional area and vascular bed compliance and resistance of the arms were similarly varied. Inter-arm differences in segmental PWV and cross-sectional area (but not bilateral changes) led to associated substantial inter-arm SBP differences, which were observed with changes to brachial, forearm and/or entire arm pathways and were related to altered transmission of forward waves and amplitude/timing of reflected waves. Vascular bed compliance and resistance had minimal influence. We conclude that inter-arm differences in arterial stiffness and geometry may contribute to inter-arm systolic blood pressure differences, warranting further investigation.

How Strongly the Body Mass Index (BMI) Is Associated with Inter Arm Blood Pressure Difference

Objectives: To explore the association between the body mass index (BMI) and inter arm difference (IAD) blood pressure and to understand how these factors influence blood pressure.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Aziz Fatimah Medical and Dental College Faisalabad Pakistan, from Nov to Dec 2020.&#x0D; Methodology: Total 100 healthy medical students aged 19-21 years were included in the study. Height in meters and weight in kilograms were documented by stadiometer (ZT-100). BMI was assessed by Quetelet's index (BMI=weight in Kg/height in m2). Blood pressure was recorded simultaneously in both arms by the auscultatory method. Inter arm difference in blood pressure was estimated by calculating differences in diastolic and systolic pressures between the right and left arm.&#x0D; Results: Mean age of the participants was 19.83 ± 1.23 years. Significant difference was noted in systolic and diastolic interarm blood pressure among obese and non-obese groups (p-values &lt;0.001). BMI was positively associated with diastolic and systolic inter-arm blood pressure (p-values &lt;0.001).&#x0D; Conclusion: Body mass index is positively associated with inter arm difference in blood pressure, and both positively impact the blood pressure.

Subclavian Artery Calcification: A Narrative Review.

Subclavian artery calcification (SAC) affects 2% of the population and presents a serious risk of developing into subclavian steal syndrome (SSS). Risk factors for plaque formation of the subclavian artery include diabetes, hypertension, and smoking. While SAC generally presents as asymptomatic, symptoms in severe cases may include numbness, pain at rest, and ischemic gangrene. Patients with severe SSS are at high risk of developing neurological symptoms as a result of vertebrobasilar insufficiency affecting posterior cerebral perfusion. On physical examination, SSS is preliminarily diagnosed from bilateral inter-arm systolic blood pressure discrepancy (>10 mmHg), which can be further confirmed with vascular imaging. Duplex ultrasound (DUS) is a cost-effective and non-invasive baseline technique for visualizing luminal stenosis and quantifying peak systolic velocity (PSV). Computed tomography angiography (CTA) provides high-quality, fast, three-dimensional (3D) imaging at the cost of introducing nephrotoxic contrast agents. Magnetic resonance angiography (MRA) is the safest 3D imaging modality, without the use of X-rays and contrast agents, that is useful in assessing plaque characteristics and degree of stenosis. DUS-assisted digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis in the subclavian artery and determining the distance between the puncture site and lesion, which can be carried out in a combined procedure with endovascular management strategies. The fundamental treatment options are surgical and endovascular intervention. Endovascular treatment options include percutaneous transluminal angiography (PTA) for recanalization of the stenosed vessel and permanent balloon stenting to prevent collapse after PTA. Overall, the benefits of endovascular management encompass faster recovery, lower stenosis recurrence rate, and lower incidence of complications, making it the treatment of choice in low-risk patients. Surgical interventions, although more complex, are considered gold-standard treatment options.

Inter-arm systolic blood pressure difference: non-persistence and association with incident cardiovascular disease in the Multi-ethnic Study of Atherosclerosis.

We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.