Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality-Reference-Cited by-同舟云学术

Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality

Published:2021-02 Issue:2 Volume:77 Page:650-661
ISSN:0194-911X
Container-title:Hypertension
language:en
Short-container-title:Hypertension

Author:

Clark Christopher E.¹^ORCID,Warren Fiona C.¹,Boddy Kate²^ORCID,McDonagh Sinead T.J.¹^ORCID,Moore Sarah F.¹^ORCID,Goddard John²^ORCID,Reed Nigel²^ORCID,Turner Malcolm²,Alzamora Maria Teresa³,Ramos Blanes Rafel⁴^ORCID,Chuang Shao-Yuan⁵^ORCID,Criqui Michael⁶,Dahl Marie⁷⁸^ORCID,Engström Gunnar⁹,Erbel Raimund¹⁰,Espeland Mark¹¹,Ferrucci Luigi¹²,Guerchet Maëlenn¹³,Hattersley Andrew¹⁴,Lahoz Carlos¹⁵,McClelland Robyn L.¹⁶,McDermott Mary M.¹⁷^ORCID,Price Jackie¹⁸,Stoffers Henri E.¹⁹,Wang Ji-Guang²⁰,Westerink Jan²¹,White James²²,Cloutier Lyne²³^ORCID,Taylor Rod S.¹²⁴^ORCID,Shore Angela C.²⁵,McManus Richard J.²⁶,Aboyans Victor²⁷,Campbell John L.¹

Affiliation:

1. From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England

2. Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England

3. Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.)

4. Unitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d’Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)

5. Institute of Population Health Sciences, National Health Research Institutes (NHRI), Taiwan, R.O.C (S.-Y.C.)

6. Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (M.C.)

7. Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark (M.D.)

8. Department of Clinical Medicine, Aarhus University, Denmark (M.D.)

9. Department of Clinical Science in Malmö, Lund University, Sweden (G.E.)

10. Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany (R.E.)

11. Wake Forest School of Medicine, NC (M.E.)

12. National Institute on Aging, Baltimore MD (L.F.)

13. INSERM U1094 & IRD, Tropical Neuroepidemiology, Institut d’Epidémiologie et de Neurologie Tropicale (IENT), Faculté de Médecine de l’Université de Limoges, Limoges Cedex, France (M.G., V.A.)

14. Institute of Biomedical and Clinical Science (A.H.), University of Exeter Medical School, College of Medicine & Health, Devon, England

15. Lípid and Vascular Risk Unit, Internal Medicine Service, Carlos III, La Paz Hospital, Madrid, Spain (C.L.)

16. Department of Biostatistics, University of Washington, WA (R.L.M.)

17. Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)

18. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)

19. Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands (H.E.S.)

20. Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)

21. Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands (J. Westerink)

22. DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Wales (J. White)

23. Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Canada (L.C.)

24. MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Scotland (R.S.T.)

25. NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter College of Medicine & Health, England (A.C.S.)

26. Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)

27. Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.).

Abstract

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02–1.08) and 1.06 (95% CI, 1.02–1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01–1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00–1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01–1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06–1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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