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

Duprez, Daniel; Jacobs, David R.; Andrews, Leah; Brumback, Lyndia C.; Denenberg, Julie O.; McClelland, Robyn L.; Thomas, Isac C.; Criqui, Michael H.; Allison, Matthew

doi:10.1038/s41371-022-00669-x

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…In a large cross-sectional, population-based study in rural and urban Malawi, measurements always in the right arm were used [ 31 ] in contrast to the WHO Steps survey, where BP measurements had to be taken always in the left arm [ 78 ]. Inter-arm pressure differences are inconsistent [ 79 ] and often not reproducible [ 80 ]. The BP is typically higher in the right arm [ 79 , 81 ] and this has been explained by the handedness of people: right arm systolic BP ≥ 5 mmHg higher than left arm in 64% of right-handed participants (1,730 of 2,692 healthy volunteers) and left arm systolic BP ≥ 5 mmHg higher than right arm in 62% of left-handed participants (211 of 338 healthy volunteers) with differences < 5 mmHg in 30% and 35%, respectively [ 82 ].…”

Section: Discussionmentioning

confidence: 99%

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

et al. 2023

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Background Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. Methods Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. Results 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). Conclusion Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. Trial registration NCT02381275. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

et al. 2023

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“…The results of the study conducted by Sharma et al showed that 46% of the participants had a systolic blood pressure difference of 10 mmHg and more 10 . Based on previous studies, there is a positive and significant relationship between the inter-arm blood pressure difference and the occurrence of cardiovascular diseases 11,12 . In Iran, few studies with sufficient sample size have investigated the relationship between the difference in inter-arm systolic and diastolic OPEN 1 Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.…”

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confidence: 98%

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

Sharafi,

Amiri,

Haghjoo

et al. 2023

Sci Rep

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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.

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Contralateral differences in ankle SBP and pulse wave velocity: associations with incident heart failure and mortality

Charry,

Xu,

Meyer

et al. 2024

Journal of Hypertension

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Background: Contralateral differences in brachial SBP are indicative of underlaying cardiovascular issues. Objectives: To examine the association of contralateral differences in ankle SBP, brachial-ankle pulse wave velocity (baPWV), and heart-ankle pulse wave velocity (haPWV) with incident heart failure and all-cause and cardiovascular mortality. Methods: Cox proportional-hazards models were used to calculate hazard ratios and 95% confidence intervals (95% CIs) in 5077 participants (75 ± 5 years) of the Atherosclerosis Risk in Communities study. Results: Over a mean follow-up of 7.5 ± 2.2 years, there were 457 heart failure events, 1275 all-cause and 363 cardiovascular deaths. Interankle SBP difference of at least 10 mmHg [hazard ratio = 1.12; confidence interval (CI) 1.00–1.28], at least 15 mmHg (hazard ratio = 1.21; CI 1.03–1.43), contralateral difference in baPWV more than 240 cm/s (hazard ratio = 1.22; CI 1.02–1.46), and haPWV more than 80 cm/s (hazard ratio = 1.24; CI 1.04–1.48) were each independently associated with all-cause mortality after adjustment for confounders. Contralateral differences in ankle SBP of at least 15 mmHg (hazard ratio = 1.56; CI 1.17–2.09), and haPWV more than 80 cm/s (hazard ratio = 1.42; CI 1.03–1.96) were both independently associated with cardiovascular mortality. Unadjusted analysis revealed that those with contralateral differences in ankle SBP of at least 10 and at least 15 mmHg, baPWV more than 240, and haPWV more than 80 cm/s had higher risks of heart failure (all P < 0.05). Conclusion: These results underscore the significance of evaluating contralateral differences in ankle SBP and PWV as potential markers of increased mortality risk among older adults.

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

Cited by 4 publications

References 29 publications

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

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

Contralateral differences in ankle SBP and pulse wave velocity: associations with incident heart failure and mortality

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