Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease

Int J Cardiol. 2017 Oct 1;244:271-276. doi: 10.1016/j.ijcard.2017.06.044. Epub 2017 Jun 13.

Abstract

Background: Inter-arm systolic blood pressure difference (SBPD) is an easily obtained patient characteristic which relates to vascular disease. We aimed to identify determinants of large inter-arm SBPD and to investigate the relation between inter-arm SBPD and vascular events in patients with and without manifest vascular disease.

Methods: In a cohort of 7344 patients with manifest vascular disease or vascular risk factors alone enrolled in the Second Manifestations of ARTerial disease (SMART) study, single bilateral non-simultaneous blood pressure measurements were performed. Logistic and Cox regression was used to identify determinants of large inter-arm SBPD (≥15mmHg) and to investigate the relation between inter-arm SBPD and vascular events (composite of non-fatal myocardial infarction, stroke, and vascular mortality) and all-cause mortality.

Results: In all patients the median inter-arm SBPD was 7mmHg (IQR 3-11) and 1182 (16%) patients had inter-arm SBPD ≥15mmHg. Higher age, higher systolic blood pressure, diabetes mellitus, peripheral artery disease, carotid artery stenosis, higher carotid intima-media thickness, and lower ankle-brachial indices were related to large inter-arm SBPD (≥15mmHg). Each 5mmHg increase in inter-arm SBPD was related to a 12% higher risk of vascular events in patients without manifest vascular disease (HR 1.12; 95% CI 1.00-1.27), whereas no relation was apparent in patients with manifest vascular disease (HR 0.98; 95% CI 0.93-1.04, interaction p-value 0.036). Inter-arm SBPD was not related to all-cause mortality (HR 1.05; 95% CI 0.93-1.19).

Conclusions: Inter-arm SBPD relates to a higher risk of vascular events in patients without manifest vascular disease, whereas this relation is not apparent in patients with manifest vascular disease.

Keywords: Atherosclerosis; Inter-arm measurements; SBPD; Subclavian stenosis; Systolic blood pressure differences; Vascular disease.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Arm / blood supply*
  • Arm / physiology*
  • Blood Pressure / physiology*
  • Blood Pressure Determination / standards*
  • Blood Pressure Determination / trends
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / physiopathology*
  • Carotid Intima-Media Thickness / standards
  • Carotid Intima-Media Thickness / trends
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Prospective Studies
  • Risk Factors