Interarm blood pressure difference and risk assessment: the ECHORN cohort study

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Current guidelines recommend bilateral arm blood pressure (BP) measurement, utilizing the higher reading for clinical decisions.
• Interarm blood pressure difference (IAD) is a recognized clinical finding with potential implications for cardiovascular risk assessment.

Purpose of the Study:

• To investigate the prevalence and distribution of interarm blood pressure differences (IAD) in an adult population.
• To identify factors associated with IAD and evaluate the impact of using higher versus lower arm BP readings on BP and atherosclerotic cardiovascular disease (ASCVD) risk classification.

Main Methods:

• A cross-sectional cohort study was conducted on 2912 community-dwelling adults aged 40 years and older across four Caribbean islands.
• Blood pressure was measured simultaneously in both arms. Statistical analyses, including mixed-effects logistic and linear regression, were employed to assess associations with IAD and reclassification of BP and ASCVD risk.

Main Results:

• Prevalence of systolic IADs ≥10 mmHg was 10.7% and ≥15 mmHg was 3.3%. Diastolic IADs ≥10 mmHg occurred in 5.0% and ≥15 mmHg in 1.8% of participants.
• Higher body mass index (BMI), systolic BP, diastolic BP, and hypertension were independently associated with increased IAD (P<0.05).
• Utilizing the higher arm BP reading reclassified approximately 1 in 10 individuals to a higher BP or ASCVD risk category.

Conclusions:

• Bilateral arm BP measurement is crucial for detecting significant IAD (≥10 mmHg) in a substantial proportion of the population.
• Factors such as elevated BMI and higher BP readings are associated with an increased likelihood of significant IAD.
• Accurate BP measurement through bilateral assessment is essential for appropriate cardiovascular risk stratification.