Inter-Arm Differences in Blood Pressure and Mortality: Individual Patient Data Meta-Analysis and Development of a Prognostic Algorithm (Interpress-Ipd Collaboration)

Clark, CE; Boddy, Kate; Warren, Fiona C; McDonagh, Sinéad T J; Taylor, Rod S; Aboyans, Victor; Cloutier, Lyne; McManus, RJ; Shore, AC; Campbell, John E.

doi:10.1016/j.cjca.2018.07.212

Cited by 8 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An American study involving 3390 patients showed that IASBPD ≥10 mmHg and cardiovascular events were independently correlated (HR 1.38; 95% CI, 1.09-1.75) [14]. INTERPRESS-IPD research including 53827 participants showed that IASBPD was associated with cardiovascular mortality (HR 1.07; 95% CI, 1.03-1.12) per 5 mmHg [15]. However, a Japanese retrospective study involving 425 patients revealed no correlation between IASBPD and coronary artery disease [16]; the authors did not explain the reason for this conclusion, stating that they considered the lower prevalence of IASBPD ≥10 mmHg (8.7%) may have contributed to this finding, while the prevalence of IASBPD ≥10 mmHg was 7.05% in our study.…”

Section: Discussionmentioning

confidence: 99%

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

Fan

Zhang

et al. 2021

International Journal of Hypertension

View full text Add to dashboard Cite

Background. Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We investigated the relationship between interarm systolic blood pressure difference and coronary artery disease. Methods. We retrospectively analyzed data for patients undergoing coronary angiography and brachial-ankle pulse wave velocity examination during hospitalization from 2013 to 2018. Patients underwent simultaneous upper arm blood pressure measurement. Interarm systolic blood pressure difference (IASBPD) was defined as the absolute value of the difference between the right and left upper limb systolic blood pressure. Patients with IASBPD ≥10 mmHg constituted the high group, and those with IASBPD <10 mmHg constituted the normal group. We also recorded data for cardiovascular risk factors. Coronary artery disease was defined as ≥50% vessel stenosis or having undergone interventional therapy according to coronary angiography results. Results. Compared with the normal group, the number of patients with coronary artery disease was higher in the high group (86.1% vs. 74.6%, P = 0.029 ). Multiple logistic regression showed that IASBPD ≥10 mmHg were positively correlated with coronary artery disease (odds ratio, 2.313; 95% confidence interval, 1.086–4.509; P = 0.029 ), and as the IASBPD value increased, the correlation also gradually increased. Conclusions. IASBPD ≥10 mmHg was positively related to coronary artery disease and increased IASBPD values were correlated with coronary artery disease severity.

show abstract

Section: Discussionmentioning

confidence: 99%

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

Fan

Zhang

et al. 2021

International Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Previous individual studies and study-level meta-analyses have also failed to show a positive correlation between size of hazard ratios for prospective mortality outcomes and magnitude of IAD, 8,12 although this has recently been shown in the authors' large (>57 000 records) individual participant data meta-analysis published in 2018. 13 The present study had few people (<3%) with an IAD ≥15 mmHg; it lacked power to explore IADs above the ≥10 mmHg threshold, and the sample size available for this study was too small to demonstrate trends in risk according to level of IAD. The limitations in measurement technique discussed above could also have contributed to the differences in associations seen between 5 mmHg and 10 mmHg IAD cut-offs.…”

Section: Strengths and Limitationsmentioning

confidence: 92%

“…32 Nevertheless, these limitations make the blood pressure readings analogous to routine clinical measurements, and the prognostic value of IAD derived from sequential measurements in other studies has not differed significantly from that of simultaneous measurements. 8,13 To minimise the impact of test-to-test variability in cognitive assessments, valid criteria for a substantial reduction in cognition over time were adopted, and outcomes were adjusted for duration of follow-up. [25][26][27] The composite measure for cognitive decline has been reported from cross-sectional work, 28 but, to the authors' knowledge, it has not previously been reported in prospective analyses such as is presented here.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…The InCHIANTI cohort is representative of an older Italian population (excepting those aged ≥90 years). 33 Ethnic differences in the aetiology and prognostic importance of IAD may exist, 13,34 but this is uncertain. 31 Consequently, the authors are cautious of extrapolating these findings to other ethnic groups.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…11 A body of evidence now exists to support recognition of IAD as an early marker for subsequent vascular disease, and to quantify that risk for cardiovascular events. 12,13 Preclinical vascular damage can be observed early in the course of hypertension, 14 whereas measurable cognitive decline or a diagnosis of dementia are later consequences of exposure to raised blood pressure. 5,15 White matter lesions predict the onset of dementia; 16 their progression is slowed when hypertension is controlled, and antihypertensive treatment is associated with a reduced risk of subsequent Alzheimer's disease.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

et al. 2020

View full text Add to dashboard Cite

BackgroundSystolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiovascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline.AimTo examine associations of IAD with cognitive decline in a community population.Design and settingA prospective study of older Italian adults enrolled in the InCHIANTI study.MethodUnivariable and multivariable associations of IAD were explored with declines in mini mental state examination (MMSE) scores, Trail Making Test A and B scores, and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline.ResultsThe rate of decline for MMSE scores in 1133 participants was greater with IAD ≥5 mmHg or ≥10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD, 95% confidence interval [CI] = 1.02 to 1.31). Substantial decline in MMSE score was seen with IAD ≥5 mmHg (OR 1.41, 95% CI = 1.03 to 1.93), and in the composite outcome with IAD ≥5 mmHg (OR 1.44, 95% CI = 1.10 to 1.89) or ≥10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multivariable adjustment, an IAD ≥ 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03).ConclusionAn IAD ≥5 mmHg is associated with cognitive decline in a representative older population. Given that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.

show abstract

Moderate to severe obstructive sleep apnea is independently associated with inter-arm systolic blood pressure difference: Tokyo Sleep Heart Study

Shiina

Takata²,

Nakano³

et al. 2021

Journal of Hypertension

View full text Add to dashboard Cite

Objective: Obstructive sleep apnea (OSA) is recognized as an independent risk factor for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD), inter-ankle systolic blood pressure difference (IAND), and ankle-brachial index (ABI) are all known predictors of cardiovascular events. The aim of the present study was to investigate the association between OSA and four-limb blood pressure differences.Methods: We conducted this cross-sectional study in a large sleep cohort from Tokyo Sleep Heart Study. In 2643 consecutive patients who visited our sleep clinic for polysomnography between 2005 and 2017, all the patients underwent blood pressure measurement simultaneously in all the four limbs by oscillometric methods. Results:The prevalence rate of IAD !10 mmHg was significantly higher in the moderate OSA (15 apneahypopnea index [AHI] < 30) group (4.2%) and severe OSA (AHI ! 30) group (4.6%) than that in the no/mild (AHI < 15) OSA group (1.4%). Multivariate logistic regression analysis also identified moderate to severe OSA as being significantly associated with IAD !10 mmHg, even after adjustments for confounding variables (moderate OSA: odds ratio [OR], 4.869; 95% confidence interval [CI], 1.080-21.956; P ¼ 0.039; severe OSA: OR, 5.301; 95% CI, 1.226-22.924; P ¼ 0.026). However, there were no significant associations of the OSA severity with IAND !15 mmHg or ABI <0.9.Conclusions: Moderate to severe OSA was independently associated with the IAD, not but with the IAND or ABI.

show abstract

Inter-Arm Differences in Blood Pressure and Mortality: Individual Patient Data Meta-Analysis and Development of a Prognostic Algorithm (Interpress-Ipd Collaboration)

Cited by 8 publications

References 0 publications

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

Moderate to severe obstructive sleep apnea is independently associated with inter-arm systolic blood pressure difference: Tokyo Sleep Heart Study

Contact Info

Product

Resources

About