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Al-Makhamreh HK, Sadalla AA, Alhawari H, Bedros AW, Kahlous MM, Amer MA, Al-Mubarak BA, Hussein M, Toubasi AA, Chichan HT. Inter-Arm Blood Pressure Difference an Indicator of Coronary Artery Disease. High Blood Press Cardiovasc Prev 2023:10.1007/s40292-023-00591-4. [PMID: 37418105 DOI: 10.1007/s40292-023-00591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Considering the scarcity of the literature on the association between inter-arms blood pressure difference (IABPD) and coronary artery disease (CAD). AIM We performed this study to investigate the prevalence of IABPD within the Jordanian population and to assess if it has an association with CAD. METHODS We sampled patients visiting the cardiology clinics at the Jordan University Hospital between October, 2019 and October 2021 into two groups. Participants were divided into two groups; patients with severe CAD and control group who had no evidence of CAD. RESULTS We measured the blood pressure for a total of 520 patients. Of the included patients, 289 (55.6 %) had CAD while 231 (44.4%) were labeled as controls who were normal. A total of 221 (42.5%) participants had systolic IABPD above 10 mmHg, while 140 (26.9%) had a diastolic IABPD above 10 mmHg. Univariate analysis demonstrated that patients with CAD were significantly more likely to be older (p < 0.001), of the male gender (p < 0.001), hypertensive (p < 0.001), and having dyslipidemia (p < 0.001). Moreover, they had significantly higher IABPD differences in terms of both systolic and diastolic blood pressure (p < 0.001 and p = 0.022, respectively). Multivariate analysis showed that CAD was a positive predictor of abnormal systolic IABPD. CONCLUSION In our study, elevated systolic IABPD was associated with a higher prevalence of severe CAD. Patients with abnormal IABPD might be subjected to more specialist investigation as IABPD consistently predicts coronary artery disease, peripheral arterial disease or other vasculopathy throughout the literature.
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Affiliation(s)
- Hanna K Al-Makhamreh
- Cardiology Section, Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | | | - Hussein Alhawari
- Nephrology Section, Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Adees W Bedros
- Al-Essra Hospital, Amman, 11941, Jordan
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Maher M Kahlous
- Al-Bashir Hospital, Amman, 11151, Jordan
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammed A Amer
- Department of Internal Medicine, Hamad Medical Corporation, Doha, 3050, Qatar
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Baraa A Al-Mubarak
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Moaiad Hussein
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan.
| | - Hayder T Chichan
- Faculty of Medicine, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Inter-arm systolic blood pressure difference: non-persistence and association with incident cardiovascular disease in the Multi-ethnic Study of Atherosclerosis. J Hum Hypertens 2023; 37:197-204. [PMID: 35296776 PMCID: PMC9477971 DOI: 10.1038/s41371-022-00669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022]
Abstract
We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.
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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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Sun L, Zou T, Wang BZ, Liu F, Yuan QH, Ma YT, Ma X. Epidemiological investigation into the prevalence of abnormal inter-arm blood pressure differences among different ethnicities in Xinjiang, China. PLoS One 2018; 13:e0188546. [PMID: 29346374 PMCID: PMC5773008 DOI: 10.1371/journal.pone.0188546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/29/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The prevalence of and risk factors for IAD among different ethnicity groups was unknown. Our aim was to investigate the prevalence of and risk factors for IAD among Han, Uygur and Kazakh ethnicities in Xinjiang. China. METHODS In total, 14,618 adult participants (7,799 males and 6,819 females) were recruited from the Cardiovascular Risk Survey. A 4-stage stratified cluster random sampling method was used. The participants' personal information and medical history were assessed by questionnaire. IAD was diagnosed by a noninvasive arteriosclerosis analyzer. RESULTS The prevalence of abnormal IAD among the general population was 14.3%, with 12.5% in the Han, 14.9% in the Uygur, and 16.4% in the Kazakh populations. The prevalence of abnormal IAD among the hypertensive population was 19.4%, with 17.0% in the Han, 18.1% in the Uygur, and 22.7% in the Kazakh populations. The prevalence of abnormal IAD increased with age (all P < 0.01) but was not significantly different between the genders (all P> 0.05). Multivariate logistic regression analysis showed that age more than 45 years, obesity and hypertriglyceridemia were significantly associated with a higher prevalence of IAD. There were different risk factors for abnormal IAD in different ethnicities. Middle or old age, obesity, ABI and diabetes mellitus were risk factors for the Han population, smoking was a risk factor in the Uygur population, and obesity and PAD were risk factors in the Kazakh population. CONCLUSION The prevalence of abnormal IAD in the Kazakh participants was higher than that in the Han and Uygur populations among both the general population and the hypertensive population in Xinjiang, China. The main risk factors of IAD were age, obesity, and triglyceride levels. Different ethnicities had different kinds of risk factors for IAD.
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Affiliation(s)
- Ling Sun
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
| | - Ting Zou
- Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Department of Cardiology, Henan, Urumqi, China
| | - Bao-Zhu Wang
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
| | - Fen Liu
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
- Xin Jiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute of the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qing-Hua Yuan
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
- Xin Jiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute of the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xingjiang Medical University, Urumqi, China
- Xin Jiang Key Laboratory of Cardiovascular Disease, Clinical Medical Research Institute of the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Sato K, Sugiura T, Ohte N, Dohi Y. Association of physical activity with a systolic blood pressure difference between arms in older people. Geriatr Gerontol Int 2017; 18:95-100. [PMID: 28786517 DOI: 10.1111/ggi.13147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 11/29/2022]
Abstract
AIM A increase in interarm systolic blood pressure difference (IASBPD) is believed to lead to increased risk of cardiovascular disease and to be a predictor of future cardiovascular events. The purpose of the present study was to test the hypothesis that an increased IASBPD is associated with reduced physical activity in older people. METHODS Older people who used a geriatric health services facility (n = 147, mean age 83.3 years) were enrolled. The prevalence of IASBPD in individuals with different levels of physical activity and factors that have a crucial effect on IASBPD were investigated. The study participants were divided into three groups according to their physical activity; ambulant persons (group A), wheelchair users (group B) and bedridden persons (group C). Blood pressure around the both brachiums was simultaneously measured using two automated devices. An IASBPD of ≥10 mmHg was considered to be significant IASBPD. RESULTS The median IASBPD was 4.5 mmHg in the present study participants, and 28 participants (19.0%) had an IASBPD ≥10 mmHg. The IASBPD in group C was greater than that in group A or B. Multivariate linear regression analysis showed that physical activity was the independent predictor of IASBPD after adjustment for possible factors. Furthermore, a logistic regression analysis with the end-point of significant IASBPD showed that physical activity is an independent predictor of significant IASBPD. CONCLUSIONS Physical activity simply assessed by moving ability can predict IASBPD in older individuals. In older people, reduced physical activity might indicate the progression of silent or clinical atherosclerosis and an increased risk of cardiovascular disease. Geriatr Gerontol Int 2018; 18: 95-100.
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Affiliation(s)
- Koichi Sato
- Geriatric health services facility, Komakinomori, Komaki, Japan
| | - Tomonori Sugiura
- Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Ohte
- Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuaki Dohi
- Faculty of Rehabilitation Science, Nagoya Gakuin University, Seto, Japan
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Clark CE. The interarm blood pressure difference: Do we know enough yet? J Clin Hypertens (Greenwich) 2017; 19:462-465. [PMID: 28296043 PMCID: PMC8031127 DOI: 10.1111/jch.12982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ma W, Zhang B, Yang Y, Qi L, Meng L, Zhang Y, Huo Y. Correlating the relationship between interarm systolic blood pressure and cardiovascular disease risk factors. J Clin Hypertens (Greenwich) 2017; 19:466-471. [PMID: 28295936 DOI: 10.1111/jch.12987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 12/01/2022]
Abstract
Interarm systolic blood pressure difference (IASBPD) can predict cardiovascular disease. To investigate the relationship between IASBPD and cardiovascular disease risk factors, a total of 1426 individuals were studied. Blood pressure was assessed simultaneously and IASBPD was expressed as the absolute difference value (|R-L|). Cardiovascular disease risk factors were compared between the high IASBPD group (IASBPD ≥10 mm Hg) and the normal IASBPD group (IASBPD <10 mm Hg). An increased prevalence of hypertension, body mass index, and systolic and diastolic blood pressure were observed in the high IASBPD group (P<.05), associated with the enhanced mean values of intima-media thickness and maximum intima-media thickness (P<.05). Brachial-ankle pulse wave velocity was increased, while ankle-brachial index was lower in the high IASBPD group (P<.05). Multivariate logistic regression analysis revealed that IASBPD ≥10 mm Hg was positively associated with body mass index (odds ratio, 1.077; P=.002) and systolic blood pressure (odds ratio, 1.032; P<.001), and negatively associated with ankle-brachial index (odds ratio, 0.038; P<.001).
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Affiliation(s)
- Wei Ma
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Baowei Zhang
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Ying Yang
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Litong Qi
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Lei Meng
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Yan Zhang
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
| | - Yong Huo
- Department of Cardiovascular Disease, Peking University First Hospital, Beijing, Beijing, China
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Between-visit reproducibility of inter-arm systolic blood pressure differences in treated hypertensive patients: the coconet study. Hypertens Res 2016; 40:483-486. [DOI: 10.1038/hr.2016.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/12/2016] [Accepted: 10/24/2016] [Indexed: 12/21/2022]
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Inter-arm Blood Pressure Difference and its Relationship with Retinal Microvascular Calibres in Young Individuals: The African-PREDICT Study. Heart Lung Circ 2016; 25:855-61. [DOI: 10.1016/j.hlc.2016.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 11/24/2022]
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Grossman A, Weiss A, Grossman E. Response to the Letter by Ozturk and Colleagues Entitled: “Inter-Arm Blood Pressure Differences May Be Important in Predicting Mortality”. J Clin Hypertens (Greenwich) 2016; 18:163. [DOI: 10.1111/jch.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alon Grossman
- Department of Internal Medicine E; Rabin Medical Center Beilinson Campus; Petah Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avraham Weiss
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatrics; Rabin Medical Center Beilinson Campus; Petah Tikva Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Internal Medicine D and Hypertension Unit; The Chaim Sheba Medical Center; Tel-Hashomer Israel
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Cao K, Su H. Inter-arm systolic blood pressure difference is a useful predictor for clinical outcome. Int J Cardiol 2015; 198:81-2. [PMID: 26159241 DOI: 10.1016/j.ijcard.2015.06.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Kaiwu Cao
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Hai Su
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Weiss A, Grossman A, Beloosesky Y, Koren‐Morag N, Green H, Grossman E. Inter-Arm Blood Pressure Difference in Hospitalized Elderly Patients Is Not Associated With Excess Mortality. J Clin Hypertens (Greenwich) 2015; 17:786-91. [PMID: 26041136 PMCID: PMC8031635 DOI: 10.1111/jch.12588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/12/2023]
Abstract
Inter-arm blood pressure difference (IAD) has been found to be associated with cardiovascular mortality. Its clinical significance and association with mortality in the elderly is not well defined. This study evaluated the association of IAD with mortality in a cohort of hospitalized elderly individuals. Blood pressure (BP) was measured simultaneously in both arms in elderly individuals (older than 65 years) hospitalized in a geriatric ward from October 2012 to July 2014. During the study period, 445 patients, mostly women (54.8%) with a mean age of 85±5 years, were recruited. Systolic and diastolic IAD were >10 mm Hg in 102 (22.9%) and 76 (17.1%) patients, respectively. Patients were followed for an average of 342±201 days. During follow-up, 102 patients (22.9%) died. Mortality was not associated with systolic or diastolic IAD. It is therefore questionable whether BP should be routinely measured in both arms in the elderly.
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Affiliation(s)
- Avraham Weiss
- Department of GeriatricsRabin Medical CenterBeilinson CampusPetach TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Alon Grossman
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Internal Medicine ERabin Medical CenterBeilinson CampusPetach TikvaIsrael
| | - Yichayaou Beloosesky
- Department of GeriatricsRabin Medical CenterBeilinson CampusPetach TikvaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Nira Koren‐Morag
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Epidemiology and Preventive MedicineTel Aviv UniversityTel AvivIsrael
| | - Hefziba Green
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of Internal Medicine ERabin Medical CenterBeilinson CampusPetach TikvaIsrael
| | - Ehud Grossman
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Internal Medicine D and Hypertension UnitThe Chaim Sheba Medical CenterTel HashomerIsrael
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Ozturk C, Balta S, Ozturk A, Aparci M, Sadir S, Celik T. Inter-Arm Blood Pressure Differences May Be Important for Predicting Mortality. J Clin Hypertens (Greenwich) 2015; 18:164. [DOI: 10.1111/jch.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Cengiz Ozturk
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
| | - Sevket Balta
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
| | - Ahmet Ozturk
- Department of Geriatric Medicine; Gulhane Medical Faculty; Ankara Turkey
| | - Mustafa Aparci
- Department of Cardiology; Kasimpasa Military Hospital; Istanbul Turkey
| | - Serdar Sadir
- Department of Physiology; Gulhane Medical Faculty; Ankara Turkey
| | - Turgay Celik
- Department of Cardiology; Gulhane Medical Faculty; Ankara Turkey
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Singh S, Sethi A, Singh M, Khosla K, Grewal N, Khosla S. Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:640-650.e12. [PMID: 26160261 DOI: 10.1016/j.jash.2015.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/12/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher brachial-ankle PWVs. Presence of inter-limb BP difference may indicate higher global CV risk.
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Affiliation(s)
- Sukhchain Singh
- Department of Hospital Medicine, Ingalls Memorial Hospital, Harvey, IL, USA; Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA.
| | - Ankur Sethi
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA
| | - Mukesh Singh
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA
| | - Kavia Khosla
- Department of Science, Brown University, Providence, RI, USA
| | - Navsheen Grewal
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA; School of Public Health, University of Illinois, Chicago, IL, USA
| | - Sandeep Khosla
- Department of Cardiovascular Medicine, Mount Sinai Hospital Medical Center, Chicago, IL, USA; Department of Cardiovascular Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Inter-arm blood pressure difference and all-cause or cardiovascular mortality. Int J Cardiol 2015; 191:50-1. [DOI: 10.1016/j.ijcard.2015.04.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/30/2015] [Indexed: 11/21/2022]
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