The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study

Abstract

Background An increased inter-arm systolic blood pressure difference is an easily determined physical examination finding. The relationship between inter-arm systolic blood pressure difference and risk of future cardiovascular disease is uncertain. We described the prevalence and risk factor correlates of inter-arm systolic blood pressure difference in the Framingham Heart Study (FHS) original and offspring cohorts and examined the association between inter-arm systolic blood pressure difference and incident cardiovascular disease and all-cause mortality. Methods An increased inter-arm systolic blood pressure difference was defined as ≥10mmHg using the average of initial and repeat blood pressure measurements obtained in both arms. Participants were followed through 2010 for incident cardiovascular disease events. Multivariable Cox proportional hazards regression analyses were performed to investigate the effect of inter-arm systolic blood pressure difference on incident cardiovascular disease. Results We examined 3,390 (56.3% female) participants aged 40 years and older, free of cardiovascular disease at baseline, mean age of 61.1 years, who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). The mean absolute inter-arm systolic blood pressure difference was 4.6 mmHg (range 0 to 78). Increased inter-arm systolic blood pressure difference was present in 317 (9.4%) participants. The median follow-up time was 13.3 years, during which time 598 participants (17.6%) experienced a first cardiovascular event including 83 (26.2%) participants with inter-arm systolic blood pressure difference ≥10 mmHg. Compared to those with normal inter-arm systolic blood pressure difference, participants with an elevated inter-arm systolic blood pressure difference were older (63.0 years vs. 60.9 years), had a greater prevalence of diabetes mellitus (13.3% vs. 7.5%,), higher systolic blood pressure (136.3 mmHg vs. 129.3 mmHg), and a higher total cholesterol level (212.1 mg/dL vs. 206.5 mg/dL). Inter-arm systolic blood pressure difference was associated with a significantly increased hazard of incident cardiovascular events in the multivariable adjusted model (hazard ratio 1.38, 95% CI, 1.09 to 1.75). For each 1-standard deviation unit increase in absolute interarm systolic blood pressure difference, the hazard ratio for incident cardiovascular events was 1.07 (CI, 1.00 to 1.14) in the fully-adjusted model. There was no such association with mortality (hazard ratio 1.02, 95% CI 0.76 to 1.38). Conclusions In this community-based cohort, an inter-arm systolic blood pressure difference is common and associated with a significant increased risk for future cardiovascular events, even when the absolute difference in arm systolic blood pressure is modest. These findings support research to expand clinical use of this simple measurement.

Gender differences in the relationship between adiposity and systolic inter-arm blood pressure difference in Korea adults

“…Inaddition, sIAD levels have been found to be associated with a significantly increased risk of future cardiovascular events [18]. The prevalence of of high sIAD (23.4%) in our result is higher than those reported by Su and colleagues [19] and Kim and colleagues [20], and is lower than that reported by Clark and colleagues [21], but is similar to that reported by Tak and colleagues [22].…”

Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk

“…3 The prevalence figures reported here for IADs are high in comparison with other large cohort studies, 4,8,9 but are based on a single pair of sequential blood pressure measurements. Sequential rather than simultaneous measurements are associated with two-to threefold higher prevalences, 11,22 and prevalence is over-estimated when measurements are not repeated, 10,11,23 due at least in part to white-coat effects.…”

“…2 Some previous reports have demonstrated a clear gradient in HRs and magnitude of IADs, 4,6,9,12,36 whereas others have not. 5,8 There were relatively few events included in analyses at the higher cut-off of ≥15 mmHg difference.…”

“…8,9 Participants were recruited from primary care age-sex registers and are broadly representative of a general population. The statuses of subjects' inter-arm blood pressure difference were unknown throughout follow-up, because differences were calculated specifically for this analysis using additional data transcribed from the original recruitment screening records.…”

“…[2][3][4][5][6][7] The need to explore this association in cohorts more representative of a general population has been identified. 6 IAD in previous survival studies has been assessed using two [7][8][9] or three pairs 2,6 of blood pressure readings. Multiple readings avoid over-estimation of IADs, 10,11 but a single pair of readings can screen out individuals without an IAD.…”