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Four-limb blood pressure as predictors of mortality in elderly Chinese
Chang-Sheng Sheng1, Ming Liu, Wei-Fang Zeng
1The Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. jiguangw@gmail.com
Insights
Blood pressure differences between limbs in older adults predict mortality risk, offering better cardiovascular insights than arm blood pressure alone. This finding highlights the importance of four-limb blood pressure measurement for elderly health.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Biomedical Engineering
Background:
- The predictive power of standard blood pressure measurements for cardiovascular outcomes decreases in the elderly.
- Peripheral arterial disease markers, such as blood pressure differences across limbs, may influence cardiovascular risk in older adults.
Purpose of the Study:
- To investigate the predictive value of simultaneous four-limb blood pressure measurements for cardiovascular morbidity and mortality in an elderly Chinese population.
- To assess whether inter-limb blood pressure differences improve mortality prediction beyond traditional arm blood pressure levels and ankle-brachial index.
Main Methods:
- A prospective study involving 3133 elderly Chinese participants (≥60 years) with simultaneous four-limb blood pressure measurement.
- Calculation of blood pressure differences between the four limbs and ankle-brachial index.
- Analysis of associations between blood pressure parameters and all-cause/cardiovascular mortality over a median follow-up of 4 years using Cox proportional hazards models.
Main Results:
- Arm blood pressure levels, except for mean arterial pressure, did not significantly predict mortality.
- Decreased ankle-brachial index and increased inter-arm or inter-ankle blood pressure differences were significantly associated with higher total and cardiovascular mortality.
- Categorical analyses confirmed the predictive value of a low ankle-brachial index and large inter-limb blood pressure differences (≥10-15 mm Hg).
Conclusions:
- Inter-limb blood pressure differences, alongside ankle-brachial index, enhance the prediction of mortality in the elderly, independent of arm blood pressure.
- Simultaneous four-limb blood pressure measurement is technologically feasible and may be a valuable tool for cardiovascular risk assessment and prevention in older individuals.
Abstract:
The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P≤0.01) and 1.17 to 1.24 for cardiovascular mortality (P≤0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (≤0.90, ≤0.95, or ≤1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:11Assessing Blood pressure in the Leg
Preparation:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:28Factors affecting Blood pressure
Physiological Factors:
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure: