The inter-arm systolic blood pressure difference and risk of cardiovascular mortality: A meta-analysis of cohort studies

Abstract

The inter-arm systolic blood pressure difference (SBPD) is recommended to be in relation to potential cardiovascular disease (CVD). Previous studies yielded controversial results about the association between an inter-arm SBPD ≥ 10 mmHg or ≥15 mmHg and the risk of cardiovascular mortality. Therefore, we conducted this meta-analysis to investigate this association. We searched PubMed and Embase databases through December 31, 2014, and examined the references of retrieved articles to identify relevant cohort studies. We utilized Newcastle-Ottawa scale to assess the quality of included studies and calculated the summary risk estimates in a fixed/random-effect model. All data analyses were conducted using STATA version 11.0. A total of seven studies were identified. Compared with participants with an inter-arm SBPD < 10 mmHg, the pooled hazard ratio (HR) of CVD mortality of those with an inter-arm SBPD ≥ 10 mmHg was 1.58 (95% CI: 1.3-1.93), and the pooled HR of cardiovascular mortality of participants with an inter-arm SBPD ≥ 15 mmHg versus those with an inter-arm SBPD < 15 mmHg was 1.88 (95% CI: 1.33-2.66). The findings from the present meta-analysis indicated that the detection of an inter-arm SBPD may define a subpopulation at high risk of CVD events.

Inter‐arm systolic blood pressure dependence on hand dominance

“…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.…”

“…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.…”

“…In contrast with the 5-mmHg threshold, prior work using a similar simultaneous SBP measuring system on 407 patients with coronary artery disease (CAD) and 250 without CAD but all having cardiovascular risk-factors, indicated a forward looking predictive threshold of 10 mmHg as predictive of cardiovascular morbidity (Tokitsu et al, 2015). These include patients with overt vascular disease (Kranenburg et al, 2017), patients with hypertension (Kim et al, 2017), patients admitted to intensive care units (Rosenberger et al, 2018), and other patient populations as reported in several meta analyses (Cao et al, 2015;Clark et al, 2016;Zhou et al, 2016). There have been a variety of other studies that have focused on characterizing inter-arm pressure differences in variously compromised patients.…”

“…There have been a variety of other studies that have focused on characterizing inter-arm pressure differences in variously compromised patients. These include patients with overt vascular disease (Kranenburg et al, 2017), patients with hypertension (Kim et al, 2017), patients admitted to intensive care units (Rosenberger et al, 2018), and other patient populations as reported in several meta analyses (Cao et al, 2015;Clark et al, 2016;Zhou et al, 2016). However, to a much lesser extent have inter-arm SBP differentials been studied in healthy populations (Fotherby et al, 1993;Grossman et al, 2013;Kim et al, 2013) and none have separately considered the role of handedness as it may relate to measured inter-arm SBP differences.…”

Association of interarm blood pressure difference with cardio‐cerebral vascular disease: A community‐based, cross‐sectional study

“…It is recommended to measure blood pressure (BP) in both arms at patients’ initial evaluation because there are differences in the BP values measured in both arms . A review of series reported prevalences of the IAD ranging from 12.0% to 18.4% for a sIAD ≥20 mm Hg and from 13.0% to 33.7% for a dIAD ≥10 mm Hg in different populations; substantial evidence has indicated that IAD, especially sIAD, is an independent risk factor for ischemic stroke, left ventricular hypertrophy, and other fatal and nonfatal cardiovascular events . It is still unclear whether coronary heart disease (CHD) or cerebrovascular disease is more associated with sIAD/dIAD of 10 or 15 mm Hg or more.…”