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Martínez-Sánchez N, Palasí A, Pera G, Martínez LM, Albaladejo R, Torán P. [Interarm blood pressure difference: Concordance between two methods of automatic simultaneous measurement and between visits reproducibility]. Aten Primaria 2022; 54:102514. [PMID: 36423568 PMCID: PMC9681639 DOI: 10.1016/j.aprim.2022.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE An increased interarm blood pressure difference (IAD) (≥10mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. DESIGN Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. SITE: Parets del Vallès primary care centre (Barcelona). PARTICIPANTS General population aged 35-74 years. INTERVENTIONS AND MAIN MEASUREMENTS One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. RESULTS Concordance for IAD expressed continuously was low: CCL=0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k=-0.03 (-0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL=0.19 (0.03-0.34) and k=-0.02 (-0.16-0.12) and for WBP™ CCL=0.14 (-0.01-0.29) and k=0.49 (0.33-0.64). CONCLUSIONS Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods.
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Affiliation(s)
- Nuria Martínez-Sánchez
- Centro de Atención Primaria Parets, Institut Català de la Salut, Parets del Vallès, Barcelona, España,Autor para correspondencia.
| | - Antonio Palasí
- Servicio de Neurología, Hospital Universitario Vall d́Hebron, Barcelona, España
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, España
| | | | - Raquel Albaladejo
- Centro de Atención Primaria Pinetons, Institut Català de la Salut, Ripollet, Barcelona, España
| | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Barcelona, España
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Wander GS, McDonagh STJ, Rao MS, Alagesan R, Mohan JC, Bhagwat A, Pancholia AK, Viswanathan M, Chopda MB, Purnanand A, Kapardhi PLN, Vadavi AR, Selvaraj R, Aneja P, Hardas S, Bordoloi N, Sivakadaksham N, Goswami N, Clark CE, Verberk WJ. Clinical relevance of double-arm blood pressure measurement and prevalence of clinically important inter-arm blood pressure differences in Indian primary care. J Clin Hypertens (Greenwich) 2022; 24:993-1002. [PMID: 35811439 PMCID: PMC9380175 DOI: 10.1111/jch.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
Hypertension guidelines recommend measuring blood pressure (BP) in both arms at least once. However, this is seldom done due to uncertainties regarding measurement procedure and the implications of finding a clinically important inter‐arm BP difference (IAD). This study aimed to provide insight into the prevalence of clinically important IADs in a large Indian primary care cohort. A number of 134 678 (37% female) unselected Indian primary care participants, mean age 45.2 (SD 11.9) years, had BP measured in both arms using a standardized, triplicate, automated simultaneous measurement method (Microlife WatchBP Office Afib). On average, there were clinically minor differences in right and left arm BP values: systolic BP 134.4 vs 134.2 mmHg (p < .01) and diastolic BP 82.7 vs 82.6 mmHg (p < .01), respectively. Prevalence of significant mean systolic IAD between 10 and 15 mmHg was 7,813 (5.8%). Systolic IAD ≥ 15 mmHg 2,980 (2.2%) and diastolic IAD ≥ 10 mmHg 7,151 (5.3%). In total, there were 7,595 (5.6%) and 8,548 (6.3%) participants with BP above the 140/90 mmHg threshold in only the left or right arm, respectively. Prevalence of participants with elevated BP on one arm only was highest in patients with a systolic IAD ≥ 15 mmHg; 19.1% and 13.7%, for left and right arm, respectively. This study shows that a substantial prevalence of IAD exists in Indian primary care patients. BP is above the diagnostic threshold for hypertension in one arm only for 6% of participants. These findings emphasize the importance of undertaking bilateral BP measurement in routine clinical practice.
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Affiliation(s)
- Gurpreet S Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Sinead T J McDonagh
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | | | - R Alagesan
- G. A. Vasant Compu Cardiac Scan Centre, Chennai, India
| | - J C Mohan
- Jaipur Golden Hospital Rohini, Delhi, India
| | | | | | | | | | | | | | | | - R Selvaraj
- Preetham Cardiac Care, Coimbatore, India
| | | | - Suhas Hardas
- Poona Hospital and Research Center, Pune & Clinic: Hardas Heart Care, Pune, India
| | | | | | | | - Christopher E Clark
- Primary care research group, College of Medicine and Health, University of Exeter, UK
| | - Willem J Verberk
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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Clark CE. Inter-arm blood pressure difference, when is it a useful risk marker for cardiovascular events? J Hum Hypertens 2022; 36:117-119. [PMID: 34741123 PMCID: PMC8850189 DOI: 10.1038/s41371-021-00629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Christopher E. Clark
- grid.8391.30000 0004 1936 8024Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine & Health, Smeall Building, St Luke’s Campus, Magdalen Road, Exeter, Devon, EX1 2LU England
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Yu Y, Liu L, Lo K, Tang S, Feng Y. Prevalence and associated factors of inter-arm blood pressure difference in Chinese community hypertensive population. Postgrad Med 2020; 133:188-194. [PMID: 32942940 DOI: 10.1080/00325481.2020.1826184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence and associated factors of inter-arm blood pressure difference (IAD) in Chinese community hypertensive population. METHODS The cross-sectional study included 7788 hypertensive patients (3673 male and 4115 female, aged 62.3 ± 13.6 years) in Guangdong, China. IAD was defined as the absolute value of blood pressure (BP) difference between left and right arms. Bilateral BP was measured simultaneously by automated devices. RESULTS The mean IAD was 4.04 ± 4.33 mm Hg in systolic and 3.19 ± 3.43 mm Hg in diastolic. The prevalence rates of systolic IAD (sIAD)≥5 mm Hg and ≥10 mmHg were 28.9% (n = 2247) and 12.8% (n = 996), respectively. By univariate linear regression, higher sIAD correlated with aging, higher SBP, higher DBP, lower baseline estimated glomerular filtration rate (eGFR), and anti-hypertensive medication (p < 0.05). In multivariate linear regression analysis, higher sIAD was significantly associated with systolic BP (SBP, β = 0.033; 95%CI, 0.025-0.041; p < 0.001), triacylglycerol (β = 0.093; 95%CI, 0.017-0.169; p = 0.016), total cholesterol (β = -0.202; 95%CI, -0.396to -0.009; p = 0.04), and low-density lipoprotein cholesterol (LDL-C; β = 0.304; 95%CI, 0.027-0.582; p = 0.032). CONCLUSION The elevated prevalence of large IAD was shown in hypertensive population. Meanwhile, higher levels of SBP, triacylglycerol, total cholesterol, LDL-C, and lower eGFR were associated with higher sIAD.
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Affiliation(s)
- Yuling Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China.,Second Clinical Medical College, Southern Medical University, 510080 Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China.,Center for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Songtao Tang
- Department of Cardiology, Community Health Center of Liaobu Town, 523400 Dongguan, Guangdong, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
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Characterization of resting and exercise inter-arm differences in SBP to isometric handgrip exercise in males and females. Blood Press Monit 2020; 25:252-258. [PMID: 32675474 DOI: 10.1097/mbp.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large inter-arm difference (IAD; ≥10 mmHg) in SBP is linked to cardiovascular and peripheral vascular disease, hypertension, and premature mortality. Exercise-induced IAD (eIAD) is related to resting IAD, and acute aerobic activity alters eIAD and reduces IAD in recovery. Isometric handgrip exercise (IHE) affects blood pressure (BP), though the eIAD response to IHE is unknown. Further, the eIAD response may differ between males and females. OBJECTIVES To characterize the eIAD response to IHE in males and females. METHODS On visit 1, participants (16 females and 15 males, aged 18-35 years) completed three maximal voluntary isometric contractions (MVIC) per arm. On visit 2, before IHE, a series of three simultaneous, bilateral BP measures were averaged at rest. During IHE, participants maintained handgrip at 20% of MVIC for 2 minutes (arm randomly assigned), at which time bilateral BP was measured (IHE) during exercise and subsequent recovery (REC1 and REC2). Repeated-measures analysis of variance assessed eIAD and SBP (time × sex). RESULTS IHE increased absolute eIAD (4 mmHg). Differences in relative eIAD were observed at IHE and REC2 based on resting IAD status (P < 0.05). Females only had an exaggerated SBP and pulse pressure response in the working arm. CONCLUSION Acute IHE was shown to augment eIAD. Further eIAD and resting IAD were related. Acute IHE induced different bilateral responses between males and females, though the impact of sex on eIAD warrants further investigation. Future studies should address the effects of repeated bouts of IHE, which may benefit individuals with a large resting IAD.
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Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension. Blood Press Monit 2020; 25:26-33. [DOI: 10.1097/mbp.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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