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Associations between interarm differences in blood pressure and cardiovascular disease outcomes: protocol for an
Christopher E Clark1, Kate Boddy2, Fiona C Warren1
1Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter, Devon, UK.
Insights
Interarm differences (IAD) in blood pressure predict cardiovascular mortality. This study uses individual patient data meta-analysis to refine risk prediction models and identify critical IAD thresholds for elevated risk.
Area of Science:
- Cardiovascular epidemiology
- Biostatistics
- Clinical risk prediction
Background:
- Interarm differences (IAD) in blood pressure are linked to increased cardiovascular and all-cause mortality.
- Existing studies and meta-analyses highlight this association but leave key prognostic questions unanswered.
Purpose of the Study:
- To quantify the additional contribution of IAD to cardiovascular risk prediction.
- To determine the minimum IAD cut-off value indicating elevated risk.
- To assess the prognostic value of IAD and the impact of measurement methods.
Main Methods:
- Conducting an individual patient data (IPD) meta-analysis of prospective cohort studies measuring blood pressure in both arms.
- Utilizing one-stage meta-analysis and multivariable time-to-event regression modeling.
- Exploring subgroup variations and the influence of different IAD measurement techniques.
Main Results:
- (To be determined by the study) - Anticipated to establish the prognostic significance of IAD.
- (To be determined by the study) - Anticipated to identify a threshold for increased cardiovascular risk.
- (To be determined by the study) - Anticipated to clarify the impact of measurement methods on risk prediction.
Conclusions:
- (To be determined by the study) - Expected to provide a refined cardiovascular risk prediction model incorporating IAD.
- (To be determined by the study) - Findings will inform clinical practice regarding the significance of blood pressure interarm differences.
- (To be determined by the study) - Will establish evidence-based guidelines for IAD measurement and interpretation.
Introduction:
Individual cohort studies in various populations and study-level meta-analyses have shown interarm differences (IAD) in blood pressure to be associated with increased cardiovascular and all-cause mortality. However, key questions remain, such as follows: (1) What is the additional contribution of IAD to prognostic risk estimation for cardiovascular and all-cause mortality? (2) What is the minimum cut-off value for IAD that defines elevated risk? (3) Is there a prognostic value of IAD and do different methods of IAD measurement impact on the prognostic value of IAD? We aim to address these questions by conducting an individual patient data (IPD) meta-analysis.
Methods And Analysis:
This study will identify prospective cohort studies that measured blood pressure in both arms during recruitment, and invite authors to contribute IPD datasets to this collaboration. All patient data received will be combined into a single dataset. Using one-stage meta-analysis, we will undertake multivariable time-to-event regression modelling, with the aim of developing a new prognostic model for cardiovascular risk estimation that includes IAD. We will explore variations in risk contribution of IAD across predefined population subgroups (eg, hypertensives, diabetics), establish the lower limit of IAD that is associated with additional cardiovascular risk and assess the impact of different methods of IAD measurement on risk prediction.
Ethics And Dissemination:
This study will not include any patient identifiable data. Included datasets will already have ethical approval and consent from their sponsors. Findings will be presented to international conferences and published in peer reviewed journals, and we have a comprehensive dissemination strategy in place with integrated patient and public involvement.
Prospero Registration Number:
CRD42015031227.
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