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Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease
Takanori Tokitsu1, Eiichiro Yamamoto, Yoshihiro Hirata
1Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Insights
Inter-arm blood pressure differences (IAD) are elevated in coronary artery disease (CAD) patients and indicate increased cardiovascular event risk. Measuring IAD with ankle-brachial index (ABI) aids risk stratification in CAD.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Tools
Background:
- Inter-arm blood pressure differences (IAD) are emerging risk factors for cardiovascular events.
- Limited research exists on IAD in patients with established coronary artery disease (CAD).
Purpose of the Study:
- To investigate the association between IAD and the presence, severity, and future cardiovascular events in patients with suspected CAD.
- To evaluate the utility of IAD measurement in risk stratification for CAD patients.
Main Methods:
- Blood pressure was measured bilaterally using the ankle-brachial index (ABI) in 657 patients with suspected CAD.
- Coronary angiography assessed CAD presence, and the Gensini score quantified coronary atherosclerosis severity.
- Patients were followed for cardiovascular events over a mean period of approximately 827 days.
Main Results:
- Mean IAD was significantly higher in patients with CAD compared to those without (P=0.01).
- High IAD (≥10 mmHg) correlated with greater Gensini scores (P=0.01) and a higher probability of future cardiovascular events (P<0.01).
- High IAD was an independent predictor of cardiovascular events (HR: 2.90, P<0.01), alongside hypertension and low ABI.
Conclusions:
- Elevated IAD is associated with the presence and severity of CAD.
- An IAD exceeding 10 mmHg independently predicts future cardiovascular events in CAD patients.
- ABI-based IAD assessment can improve cardiovascular risk stratification in patients with CAD.
Objective:
Recent studies have shown that inter-arm blood pressure differences (IAD) may be a risk factor for cardiovascular events; however, none have addressed them in patients with coronary artery disease (CAD).
Methods:
We measured blood pressure bilaterally with the ankle brachial index (ABI) in 657 patients with suspected CAD and assessed the presence of CAD by coronary angiography, and the severity of coronary atherosclerosis with the Gensini score.
Results:
Mean IADs were significantly greater in risk factor matched patients with CAD than in those without it (P = 0.01), whereas Gensini scores were significantly greater in those with high IAD (≥10 mmHg) than in those with low-IAD (P = 0.01) according to cross-sectional analysis. Patients with high IAD had a significantly greater probability of cardiovascular events than those in whom it was low (log-rank test, P < 0.01, mean follow-up range; 827.3 ± 268.1 days). The presence of hypertension, ABI, usage of calcium channel blocker and high IAD were independent predictors of cardiovascular events according to longitudinal analysis (IAD; hazard ratio: 2.90, 95% confidence interval: 1.41-5.94, P < 0.01) in these patients. Patients with high IAD and peripheral artery disease had the highest Gensini scores according to cross-sectional analysis (P < 0.01) and highest probability of cardiovascular events according to longitudinal analysis (log-rank test, P < 0.001).
Conclusion:
IADs were increased in CAD patients and correlated with its severity. Greater than 10 mmHg of IAD was independently associated with future cardiovascular events. Assessing IAD by ABI measurement may facilitate risk stratification in CAD patients.
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