Inter-arm Blood Pressure Research Articles

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

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

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

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

P042: Pilot study for the inter-arm blood pressure systematic measurement during the diagnosis of transient ischemic attack in the emergency department

Introduction: Our principal aim was to document the feasibility of the systematic measurement of the inter-arm blood pressure difference (IABPD) during an episode of transient ischemic attack (TIA) or mild stroke diagnosed in the Emergency Department (ED). As secondary goal was to compare the systolic blood pressure (BP) at triage with the systolic BPs measured during the IABPD. Methods: This is a single center pilot study. Patients presenting in the ED for a diagnosis of TIA were recruited. Once patient has been triaged and diagnosed of TIA, a research assistant made sure that the patient lay on a stretcher for at least 5 minutes. Two automated sphygmomanometers were applied, on each arm. No specific device or device calibration were required. Three consecutive simultaneous BP readings were performed, inverting cuffs arm to arm between each reading. Only the last two set of readings were used to calculate the mean IABPD. This method enables to minimize the error coming from the potential sphygmomanometers’ inaccuracies. Results: 32 patients were recruited from June to September 2017 and all had a successful IABPD measurement. Four patients had an IABPD &amp;gt;10 mmHg, varying from 1.5 to 13 mmHg when the left arm was higher and from 1 to 61 mmHg when the right arm was higher. Of the 22 patients where the triage BP arm side selection was recorded, only 11 were congruent with the arm presenting the highest BP during the IABPD measurement. Selecting of the arm with the highest BP value may better reflect cerebrovascular risk exposition. The mean systolic BP at triage was 159.3 mmHg (95%CI: 144.9-173.7) compared to144.8 mmHg (95%CI: 132.9-156.7) if the arm with the highest value during the IABPD measurement is selected and 142.4 mmHg (95%CI: 130.8-154.0) if the same arm as triage is selected. The p-value for these differences were 0.003 and 0.001 respectively. The patient which presented the IABPD of 61 mmHg, had a stroke 3 days after its ED visit which subsequently led to her death 10 days later. Conclusion: Our results show that the systematic IABPD measurement using a pragmatic approach in the ED is feasible and is ready to investigate its use in the context of a new TIA or mild stroke. This information may contribute to a better discrimination of the short-term risk of stroke and may help to diagnose acute aortic dissection, monitor more accurately BP during hyperacute stroke or estimate intracerebral hemorrhage risk if systemic thrombolysis is considered.

Inter-Arm Blood Pressure Difference in a Typical University Family Medicine Clinic

Inter-Arm Blood Pressure Difference in a Typical University Family Medicine Clinic

Abstract #377 The Ankle Brachial Index Exhibits Better Association with Cardiovascular Outcomes Than Inter-Arm Systolic Blood Pressure Difference in Patients with Type 2 Diabetes

Abstract #377 The Ankle Brachial Index Exhibits Better Association with Cardiovascular Outcomes Than Inter-Arm Systolic Blood Pressure Difference in Patients with Type 2 Diabetes

Research progress on the association between inter-arm blood pressure and cardio-cerebrovascular diseases and target-organ damage

臂间血压差异指由于上臂解剖差异产生的左右臂血压差异，是临床上容易获得的无创参数。在正常人群中普遍存在臂间血压差异，但研究表明心脑血管疾病患者臂间血压差异显著高于正常人群。臂间血压差异与心脑血管疾病及其靶器官损害存在相关性，对其发生和预后具有一定的预测价值，对于血压管理和疾病风险评估意义重大。本文就臂间血压差异的评价方法、相关因素及其与心脑血管疾病及靶器官损害的研究进展作一综述。.

Inter-arm Systolic Blood Pressure Difference: A Surrogate for Diagnosis of Peripheral Arterial Disease

Inter-arm Systolic Blood Pressure Difference: A Surrogate for Diagnosis of Peripheral Arterial Disease

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

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

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.

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.

P5135Impact of obstructive sleep apnea on inter-arm blood pressure difference: a large sleep cohort study

P5135Impact of obstructive sleep apnea on inter-arm blood pressure difference: a large sleep cohort study

Simultaneously Measured Interarm Blood Pressure Difference and Stroke: An Individual Participants Data Meta-Analysis.

We conducted individual participant data meta-analysis to examine the validity of interarm blood pressure difference in simultaneous measurement as a marker to identify subjects with ankle-brachial pressure index <0.90 and to predict future cardiovascular events. We collected individual participant data on 13 317 Japanese subjects from 10 cohorts (general population-based cohorts, cohorts of patients with past history of cardiovascular events, and those with cardiovascular risk factors). Binary logistic regression analysis with adjustments identified interarm blood pressure difference >5 mm Hg as being associated with a significant odds ratio for the presence of ankle-brachial pressure index <0.90 (odds ratio, 2.19; 95% confidence interval, 1.60-3.03; P<0.01). Among 11 726 subjects without a past history of cardiovascular disease, 249 developed stroke during the average follow-up period of 7.4 years. Interarm blood pressure difference >15 mm Hg was associated with a significant Cox stratified adjusted hazard ratio for subsequent stroke (hazard ratio, 2.42; 95% confidence interval, 1.27-4.60; P<0.01). Therefore, interarm blood pressure differences, measured simultaneously in both arms, may be associated with vascular damage in the systemic arterial tree. These differences may be useful for identifying subjects with an ankle-brachial pressure index of <0.90 in the overall study population, and also a reliable predictor of future stroke in subjects without a past history of cardiovascular disease. These findings support the recommendation to measure blood pressure in both arms at the first visit.

Non-invasive measurements to stratify cardiovascular disease risk in psoriasis patients

Psoriasis is associated with cardiovascular disease (CVD) risk factors and mortality. The aims of this study were to identify CVD risk in patients with psoriasis, and to determine their awareness of the comorbidities. Patients with psoriasis and controls had their inter-arm blood pressure, weight, height and waist circumference measured at their routine clinic appointment. Those with psoriasis also completed a survey regarding awareness of the comorbidities. A total of 179 patients with psoriasis and 115 control patients participated in the study. Patients with psoriasis were significantly more likely to be obese (odds ration [OR] 6.3). An inter-arm blood pressure difference >10 mmHg was more likely in patients with psoriasis for systolic (OR 1.9) and diastolic (OR 2.3) readings. Survey data showed that 47 (26.3%) psoriasis patients knew that psoriasis was associated with being overweight. On the basis of anthropologic measurements, patients with psoriasis have a higher risk of CVD, compared with non-psoriasis patients. There is inadequate knowledge among psoriasis patients regarding the comorbidities of psoriasis.

Correction: Epidemiological investigation into the prevalence of abnormal inter-arm blood pressure differences among different ethnicities in Xinjiang, China.

[This corrects the article DOI: 10.1371/journal.pone.0188546.].

Epidemiological investigation into the prevalence of abnormal inter-arm blood pressure differences among different ethnicities in Xinjiang, China.

ObjectivesThe prevalence of and risk factors for IAD among different ethnicity groups was unknown. Our aim was to investigate the prevalence of and risk factors for IAD among Han, Uygur and Kazakh ethnicities in Xinjiang. China.MethodsIn total, 14,618 adult participants (7,799 males and 6,819 females) were recruited from the Cardiovascular Risk Survey. A 4-stage stratified cluster random sampling method was used. The participants’ personal information and medical history were assessed by questionnaire. IAD was diagnosed by a noninvasive arteriosclerosis analyzer.ResultsThe prevalence of abnormal IAD among the general population was 14.3%, with 12.5% in the Han, 14.9% in the Uygur, and 16.4% in the Kazakh populations. The prevalence of abnormal IAD among the hypertensive population was 19.4%, with 17.0% in the Han, 18.1% in the Uygur, and 22.7% in the Kazakh populations. The prevalence of abnormal IAD increased with age (all P < 0.01) but was not significantly different between the genders (all P> 0.05). Multivariate logistic regression analysis showed that age more than 45 years, obesity and hypertriglyceridemia were significantly associated with a higher prevalence of IAD. There were different risk factors for abnormal IAD in different ethnicities. Middle or old age, obesity, ABI and diabetes mellitus were risk factors for the Han population, smoking was a risk factor in the Uygur population, and obesity and PAD were risk factors in the Kazakh population.ConclusionThe prevalence of abnormal IAD in the Kazakh participants was higher than that in the Han and Uygur populations among both the general population and the hypertensive population in Xinjiang, China. The main risk factors of IAD were age, obesity, and triglyceride levels. Different ethnicities had different kinds of risk factors for IAD.

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.

Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients.

Background and PurposeInterarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality.MethodsThis study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD.ResultsEND occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was <0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END.ConclusionsThis study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.

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.