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The predictive value of interarm systolic blood pressure differences in patients with vascular disease: Sub-analysis

Mohammad Qadura1, Muzammil H Syed2, Sonia Anand3

  • 1Department of Surgery, University of Toronto, Toronto, ON, M5S 1A1, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.

Atherosclerosis
|April 6, 2023
PubMed

Insights

Systolic blood pressure interarm difference (IAD) does not predict cardiovascular events in patients with established vascular disease. However, the combination of rivaroxaban and aspirin significantly reduced major adverse cardiovascular events in these patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pharmacology

Background:

  • Systolic blood pressure interarm difference (IAD) is a known predictor of cardiovascular events in primary prevention.
  • Its predictive utility in patients with established cardiovascular disease requires further investigation.

Purpose of the Study:

  • To evaluate the predictive value of IAD in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD).
  • To assess the efficacy of rivaroxaban plus aspirin versus aspirin alone in managing cardiovascular outcomes based on IAD.

Main Methods:

  • Analysis of COMPASS trial data, comparing patients with IAD <15 mmHg and IAD ≥15 mmHg.
  • Outcomes assessed included major adverse cardiovascular events (MACE) and major adverse limb events (MALE) over 30 months.
  • Treatment effects of rivaroxaban plus aspirin versus aspirin alone were evaluated within IAD subgroups.

Main Results:

  • Patients with IAD <15 mmHg showed similar incidence rates for MACE or MALE compared to those with IAD ≥15 mmHg, except for a higher stroke incidence.
  • The combination of rivaroxaban and aspirin significantly reduced MACE or MALE in both IAD groups compared to aspirin alone.
  • No significant interaction was observed between IAD status and treatment effect.

Conclusions:

  • IAD measurement is not useful for risk stratification in patients with established vascular disease.
  • Rivaroxaban plus aspirin demonstrates significant cardiovascular benefits irrespective of IAD in patients with established CAD or PAD.
Abstract

Keywords:
Antithrombotic therapyBlood pressureMajor adverse cardiovascular eventsMajor adverse limb eventsVascular disease

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