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Updated: Apr 7, 2026
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk
Sukhchain Singh1, Ankur Sethi2, Mukesh Singh2
1Department of Hospital Medicine, Ingalls Memorial Hospital, Harvey, IL, USA; Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA.
Insights
An elevated inter-arm systolic blood pressure difference (IASBPD) is a strong predictor of peripheral arterial disease (PAD). This difference may also indicate increased cardiovascular risk and other vascular issues.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Epidemiology
Background:
- The association between inter-arm systolic blood pressure difference (IASBPD) and cardiovascular (CV) outcomes is not fully established.
- Existing evidence is limited, necessitating a comprehensive review of available data.
Purpose of the Study:
- To systematically evaluate the evidence linking inter-limb blood pressure (BP) differences to cardiovascular risk and outcomes.
- To investigate the association of IASBPD and inter-leg BP difference with peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, and mortality.
Main Methods:
- A systematic search of major biomedical databases (PubMed, EMBASE, CINAHL, Cochrane library, Ovid) was conducted.
- Studies involving bilateral simultaneous BP measurements and reporting on CV risk or outcomes were included.
- Random-effect meta-analysis was employed to synthesize effect estimates from eligible studies.
Main Results:
- An IASBPD of 10 mmHg or more was significantly associated with PAD (RR 2.22) and increased left ventricular mass index.
- An IASBPD of 15 mmHg or more remained a significant predictor of PAD (RR 1.91).
- Inter-leg BP difference of 15 mmHg or more strongly predicted PAD and brachial-ankle pulse wave velocity (PWV). No significant direct association was found with coronary artery disease, cerebrovascular disease, or mortality.
Conclusions:
- Inter-arm and inter-leg blood pressure differences are robust indicators of PAD.
- IASBPD may be linked to subclavian stenosis, elevated left ventricular mass, and higher brachial-ankle PWVs.
- The presence of inter-limb BP differences suggests a potentially higher global cardiovascular risk.
Abstract:
Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher brachial-ankle PWVs. Presence of inter-limb BP difference may indicate higher global CV risk.
Related Concept Videos
01:11Assessing Blood pressure in the Leg
Preparation:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
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.
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:23Assessment of blood pressure in brachial artery(two-step method)
01:17Measurement of Blood Pressure