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Dahl M, Andersen JW, Lindholt J, Krarup NT, Borregaard B, Uberg N, Høgh A. Prevalence of interarm blood pressure difference is notably higher in women; the Viborg population-based screening program (VISP). BMC Public Health 2024; 24:1868. [PMID: 38997668 PMCID: PMC11245839 DOI: 10.1186/s12889-024-19388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Bilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm. METHODS This sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results). RESULTS We included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32-1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140-159/90-99 mmHg (OR 1.68, 95% CI 1.44-1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49-2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm. CONCLUSION Female sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening. TRIAL REGISTRATION FOR VISP NCT03395509:10/12/2018.
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Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Toldbodgade 12, Viborg, 8800, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark.
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, JB Winsløwsvej 4, Odense, 5000, Denmark.
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark.
| | - Jesper Winkler Andersen
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Toldbodgade 12, Viborg, 8800, Denmark
| | - Jes Lindholt
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Toldbodgade 12, Viborg, 8800, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, JB Winsløwsvej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
- Department of Cardiothoracic and Vascular Surgery, Elite Centre of Individualized Treatment of Arterial Diseases (CIMA), Clinical Institute, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Nikolaj Thure Krarup
- Department of Cardiology, Viborg Regional Hospital, Heibergs Alle 5A, Viborg, 8800, Denmark
| | - Britt Borregaard
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, JB Winsløwsvej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
- Department of Cardiology, Odense University Hospital, JB Winsløwsvej 4, Odense, 5000, Denmark
| | - Nikolai Uberg
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Toldbodgade 12, Viborg, 8800, Denmark
| | - Annette Høgh
- Vascular Research Unit, Department of Surgery, Viborg Regional Hospital, Toldbodgade 12, Viborg, 8800, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
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Peng HP, Tao L, Tang M, Su H. Inter-arm blood pressure difference in post-stroke patients with hemiparesis. J Hum Hypertens 2024; 38:228-231. [PMID: 38151538 DOI: 10.1038/s41371-023-00886-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
The aim of this study was to investigate that inter-arm blood pressure (BP) difference (IAD) and reference arm in 420 post-stroke patients with hemiparesis. Synchronous bilateral-arm BP was measured with two automatic BP devices, and the systolic BP difference of ≥10 mm Hg was recorded as increased sIAD. The arm with higher systolic BP (SBP) was assigned as the reference arm. Our results showed that the prevalence of sIAD was 18.1% in the total group. The paretic arms had similar mean SBP levels (133.6±18.4 vs. 133.8±18.4 mm Hg, NS) and DBP (77.8±11.5 vs. 77.2±10.9 mm Hg, NS) as compared with the unaffected arms. The detection rate of hypertension or uncontrolled hypertension on the SBP values of the reference arm was higher than that on the unaffected arm (41.8% vs. 36.3%). It is concluded that in the post-stroke patients with hemiparesis in the rehabilitation period, the prevalence of sIAD ≥10 mmHg was relatively higher, and using the unaffected arm, rather than the unaffected arm, for BP measurement could induce correctly detection of hypertension.
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Affiliation(s)
- Hai-Ping Peng
- Department of Neurology, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Liang Tao
- Department of Neurology, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Min Tang
- Department of Neurology, Ningbo Rehabilitation Hospital, Ningbo, Zhejiang, China
| | - Hai Su
- Cardiovascular Rehabilitation Center, Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China.
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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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