Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

“…This view is supported by some published work (Olmedillas et al, 2010) and it has been suggested that larger circumference arms may be associated with higher measured SBP (Loenneke et al, 2016). Furthermore, because of the widely reported potential significance of inter-arm SBP differences as a predictor of cardiovascular morbidity (Cao et al, 2015;Tokitsu et al, 2015;Zhou et al, 2016;Kranenburg et al, 2017;Hirono et al, 2018) it was believed that the issue concerning the role that handedness might play in such inter-arm pressure differences was of significance and should be specifically addressed. A third motivating factor was that most prior assessments of inter-arm pressure differences focused on either older persons or those with already present cardiovascular symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…This meant that there was little data on young and apparently healthy adults. Furthermore, because of the widely reported potential significance of inter-arm SBP differences as a predictor of cardiovascular morbidity (Cao et al, 2015;Tokitsu et al, 2015;Zhou et al, 2016;Kranenburg et al, 2017;Hirono et al, 2018) it was believed that the issue concerning the role that handedness might play in such inter-arm pressure differences was of significance and should be specifically addressed. This led to the working hypothesis that the magnitude of cuff pressures needed to compress the underlying brachial artery in determining SBP would be greater in the dominant arm thereby rendering the dominant arm to have a greater SBP.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study of 700 patients with cardiovascular diseases of various types reported that an inter-arm systolic blood pressure (SBP) difference of 5 mmHg appears to be an optimal threshold for predicting subsequent cardiovascular events (Hirono et al, 2018). Although the primary goal of that study was to suggest a useful threshold, their data revealed that in 11% of patients, the left arm exceeded the right arm SBP by at least 5 mmHg whereas in 16% of patients the right arm exceeded the left arm SBP by at least 5 mmHg with the remainder having inter-arm differentials of <5%.…”

Section: Introductionmentioning

confidence: 99%

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Inter‐arm systolic blood pressure dependence on hand dominance

Mayrovitz

2018

Clin Physio Funct Imaging

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Inter-arm systolic blood pressure differences (SBP-DIFF) ≥ 10 mmHg have been reported useful to predict future cardiovascular-related morbidities. Although well studied in patients, there is little information on healthy young adults and the role of hand-dominance as a factor affecting SBP-DIFF. As dominant arms (DOM) tend to have greater girth and muscle development than nondominant arms (NDOM) it was reasoned that cuff pressures needed to obtain SBP may be greater on DOM causing DOM SBP to be greater. To test this hypothesis and also provide typical values, SBP was measured in left and right-handers (29·4 ± 10·4 years) in whom handedness was clearly defined. Handedness was determined by a multi-question form in 90 young adults (45 male) and SBP-DIFF determined via simultaneous measurements done in triplicate on seated subjects. The percentage of left-handers in male and female sub-groups were equal at 37·8%. Results show that the absolute SBP-DIFF in left-handers (mean ± SD) was 4·4 ± 3·8 mmHg and for right-handers was 5·0 ± 4·2 mmHg (P = 0·362). There was also no statistically significant difference among 1st, 2nd and 3rd measured SBP-DIFF for either right or left-handers or differences between right and left-handers. Results show no evidence of a higher SBP in DOM and thus clarifies the hand-dominance issue as a factor not generally needing to be considered in clinical assessments. A potentially useful secondary outcome was the finding that 14·8% of this group had at least one measured SBP-DIFF ≥ 10 mmHg a fact that may have future relevance.

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“…The mean blood pressure differences between the arms could have been associated with arterial hypertension. It is important, because major difference has been associated with poor outcome [5,6] and increased mortality [7], especially in individuals with arterial hypertension [8,9]. This correlation was also investigated by other authors.…”

Section: Discussionmentioning

confidence: 92%

Różnice ciśnienia tętniczego pomiędzy kończynami górnymi u chorych z zaawansowaną miażdżycą poddawanych naczyniowej interwencji chirurgicznej

Gajniak

Mendrala

Gierek

et al. 2018

Anaesthesiol Intensive Ther

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Background: 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. Methods: The prospective study was carried out in patients scheduled for elective lower limb vascular surgery. Onetime 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. Results: 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). Conclusions: 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.

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Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

Abstract: IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg.

Cited by 17 publications

References 32 publications

Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention

Impact of decreased ankle-brachial index on 30-day bleeding complications and long-term mortality in patients with acute coronary syndrome after percutaneous coronary intervention

Inter‐arm systolic blood pressure dependence on hand dominance

Różnice ciśnienia tętniczego pomiędzy kończynami górnymi u chorych z zaawansowaną miażdżycą poddawanych naczyniowej interwencji chirurgicznej

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