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Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at
Christopher E Clark1, Rod S Taylor1, Isabella Butcher2
1Primary Care Research Group, University of Exeter Medical School, Exeter, Devon.
Insights
A significant inter-arm blood pressure difference (IAD) is linked to higher cardiovascular and all-cause mortality, even in individuals without prior vascular disease. This finding highlights IAD as a crucial indicator of cardiovascular risk.
Area of Science:
- Cardiovascular epidemiology
- Clinical risk assessment
- Public health
Background:
- Inter-arm blood pressure difference (IAD) is a known predictor of cardiovascular mortality in high-risk populations.
- However, its prognostic value in community-dwelling individuals without pre-existing vascular disease is less understood.
Purpose of the Study:
- To investigate the association between systolic inter-arm blood pressure difference (IAD) and mortality in a general population cohort.
- To determine if IAD predicts cardiovascular events and all-cause mortality in individuals free of cardiovascular disease.
Main Methods:
- Cohort analysis of a randomized controlled trial conducted in central Scotland (1998-2008).
- Systolic blood pressure was measured in both arms of 3350 participants without prior vascular disease.
- Inter-arm blood pressure differences were calculated and analyzed for associations with cardiovascular events and all-cause mortality over an 8.2-year follow-up.
Main Results:
- 60% of participants exhibited a systolic IAD ≥5 mmHg, and 38% had an IAD ≥10 mmHg.
- An IAD ≥5 mmHg was significantly associated with increased cardiovascular mortality (aHR 1.91) and all-cause mortality (aHR 1.44).
- In hypertensive subgroup, IADs ≥5 mmHg and ≥10 mmHg showed increased cardiovascular and all-cause mortality risks.
Conclusions:
- Systolic inter-arm blood pressure differences are associated with elevated risks of cardiovascular events and mortality.
- IAD serves as a valuable, easily measurable risk indicator in the general population, even in those without diagnosed vascular disease.
Background:
Differences in blood pressure between arms are associated with increased cardiovascular mortality in cohorts with established vascular disease or substantially elevated cardiovascular risk.
Aim:
To explore the association of inter-arm difference (IAD) with mortality in a community-dwelling cohort that is free of cardiovascular disease.
Design And Setting:
Cohort analysis of a randomised controlled trial in central Scotland, from April 1998 to October 2008.
Method:
Volunteers from Lanarkshire, Glasgow, and Edinburgh, free of pre-existing vascular disease and with an ankle-brachial index ≤0.95, had systolic blood pressure measured in both arms at recruitment. Inter-arm blood pressure differences were calculated and examined for cross-sectional associations and differences in prospective survival. Outcome measures were cardiovascular events and all-cause mortality during mean follow-up of 8.2 years.
Results:
Based on a single pair of measurements, 60% of 3350 participants had a systolic IAD ≥5 mmHg and 38% ≥10 mmHg. An IAD ≥5 mmHg was associated with increased cardiovascular mortality (adjusted hazard ratio [HR] 1.91, 95% confidence interval [CI] = 1.19 to 3.07) and all-cause mortality (adjusted HR 1.44, 95% CI = 1.15 to 1.79). Within the subgroup of 764 participants who had hypertension, IADs of ≥5 mmHg or ≥10 mmHg were associated with both cardiovascular mortality (adjusted HR 2.63, 95% CI = 0.97 to 7.02, and adjusted HR 2.96, 95% CI = 1.27 to 6.88, respectively) and all-cause mortality (adjusted HR 1.67, 95% CI = 1.05 to 2.66, and adjusted HR 1.63, 95% CI = 1.06 to 2.50, respectively). IADs ≥15 mmHg were not associated with survival differences in this population.
Conclusion:
Systolic IADs in blood pressure are associated with increased risk of cardiovascular events, including mortality, in a large cohort of people free of pre-existing vascular disease.
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