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Qadura M, Syed MH, Anand S, Bosch J, Connolly S, Aboyans V, Muehlhofer E, Yusuf S, Eikelboom J. The predictive value of interarm systolic blood pressure differences in patients with vascular disease: Sub-analysis of the COMPASS trial. Atherosclerosis 2023; 372:41-47. [PMID: 37023507 DOI: 10.1016/j.atherosclerosis.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND AIMS Systolic blood pressure interarm difference (IAD) predicts cardiovascular morbidity and mortality in primary prevention populations. We examined the predictive value of IAD and the effects of treatment with the combination of rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily versus aspirin 100 mg once daily according to IAD in patients with chronic coronary artery disease or peripheral artery disease. METHODS COMPASS trial patients with IAD <15 mmHg and IAD >15 mmHg were compared with respect to thirty-month incidence risk of: 1) composite of stroke, myocardial infarction, or cardiovascular death (MACE), 2) composite of acute limb-ischemia or vascular amputation (MALE), 3) composite of MACE or MALE, and 4) effects of treatment with the combination versus aspirin alone on these outcomes. RESULTS 24,539 patients had IAD<15 mmHg and 2,776 had IAD ≥15 mmHg. Relative to patients with IAD ≥15 mm Hg, those with IAD<15 mmHg had similar incidence rates for all measured outcomes including the composite of MACE or MALE (HR 1.12 [95% CI: 0.95 to 1.31], p = 0.19), with the exception of stroke (HR 1.38 [95% CI: 1.02 to 1.88], p = 0.04). Compared to aspirin alone, the combination consistently reduced the composite of MACE or MALE in both IAD <15 mmHg (HR 0.74 [95% CI: 0.65-0.85], p < 0.0001, ARR = -23.1) and IAD>15 mmHg (HR 0.65 [95% CI: 0.44-0.96], p = 0.03; ARR = -32.6, p interaction = 0.53) groups. CONCLUSIONS Unlike primary prevention populations, measuring IAD for risk stratification purposes does not appear to be useful in patients with established vascular disease.
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Affiliation(s)
- Mohammad Qadura
- Department 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.
| | - Muzammil H Syed
- Department of Surgery, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Sonia Anand
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France; EpiMaCT, INSERM U1094, IRD U270, Limoges University, Limoges, France
| | - Eva Muehlhofer
- Department Pharma Research & Development Bayer AG, Wuppertal, Germany
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Hwang HJ, Sohn IS, Kim DH, Park CB, Cho JM, Kim CJ. Increased interarm blood pressure difference is associated with autonomic dysfunction and atherosclerosis in patients with chest pain and no history of coronary artery disease. Int J Cardiol 2017; 241:25-29. [DOI: 10.1016/j.ijcard.2017.03.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/10/2017] [Accepted: 03/13/2017] [Indexed: 11/26/2022]
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Canepa M, Milaneschi Y, Ameri P, AlGhatrif M, Leoncini G, Spallarossa P, Pontremoli R, Brunelli C, Strait JB, Lakatta EG, Ferrucci L. Relationship between inter-arm difference in systolic blood pressure and arterial stiffness in community-dwelling older adults. J Clin Hypertens (Greenwich) 2013; 15:880-7. [PMID: 24299691 DOI: 10.1111/jch.12178] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/02/2013] [Accepted: 07/07/2013] [Indexed: 11/30/2022]
Abstract
A significant inter-arm difference in systolic blood pressure (IADSBP) has recently been associated with worse cardiovascular outcomes. The authors hypothesized that part of this association is mediated by arterial stiffness, and examined the relationship between significant IADSBP and carotid-femoral pulse wave velocity (CF-PWV) in a sample from the Baltimore Longitudinal Study of Aging. Of 1045 participants, 50 (4.8%) had an IADSBP ≥10 mm Hg at baseline, and 629 had completed data from ≥2 visits (for a total of 1704 visits during 8 years). CF-PWV was significantly higher in patients with an IADSBP ≥10 mm Hg (7.3±1.9 vs 8.2±2, P=.002). Compared with others, patients with IADSBP ≥10 mm Hg also had higher body mass index, waist circumference, and triglycerides; higher prevalence of diabetes; and lower high-density lipoprotein (HDL) cholesterol (P<.001 for all). A significant association with IADSBP ≥10 mm Hg was observed for CF-PWV in both cross-sectional (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06-1.87; P=.01) and longitudinal (OR, 1.15; 95% CI, 1.03-1.29; P=.01) multivariate analyses. Female sex, Caucasian race, high body mass index (plus diabetes and low HDL cholesterol only cross-sectionally) were other independent correlates of IADSBP ≥10 mm Hg. Significant IADSBP is associated with increased arterial stiffness in community-dwelling older adults.
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Affiliation(s)
- Marco Canepa
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, MD; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, NIA/NIH, Baltimore, MD; Department of Internal Medicine, University of Genova, Genova, Italy
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