— Systolic Interarm Differences in Blood Pressure Linked to Increased Cardiovascular Events and Mortality

MedicalResearch.com Interview with:

Dr-Chris Clark.jpg

Dr. Clark

Chris Clark, PhD
Clinical Senior Lecturer in General Practice
Primary Care Research Group
St Luke’s Campus, Exeter

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: Various individual studies have suggested that a blood pressure difference between arms is associated with increased mortality and cardiovascular events since we first reported this association in 2002. Such studies have been limited, due to smaller numbers of participants, in the conclusions that could be drawn. Therefore we sought to pool data from as many cohorts as possible to study this association in more detail. 

MedicalResearch.com: What are the main findings? Should it be standard practice to measure blood pressure in both arms?

Response: Systolic inter-arm difference was associated with increased all-cause and cardiovascular mortality. We found that all-cause mortality increased with inter-arm difference magnitude from a ≥5 mmHg threshold. Systolic inter-arm difference was also associated with cardiovascular events in people without pre-existing disease. This remained significant after adjustment for various internationally used cardiovascular risk scores, namely ASCVD, Framingham or QRISK2. Essentially we found that each increase of 1mmHg in inter-arm difference equated to a 1% increase for a given cardiovascular risk score.

When undertaking a cardiovascular assessment, or determining which arm should be used for blood pressure measurement, it is recommended to measure both arms.

MedicalResearch.com: What should readers take away from your report?

Response: Our findings confirm that systolic inter-arm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment, not only to identify the higher reading arm, but also to identify additional risk conferred by an inter-arm difference. We propose that a systolic inter-arm difference of 10 mmHg should be adopted as the upper limit of normal.

taking blood pressure- CDC imageOur findings are based on sequential arm measurements that can be achieved with standard sphygmomanometer in any clinical settling. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: We need to study how this new information can be best implemented into routine primary care, and there is further mechanistic work to undertake to describe in greater detail the underlying cause(s) of inter-arm differences. 

Disclosures: CEC has received an honorarium from Bayer (unrelated to IAD work) and has been loaned bilateral BP monitors by Microlife and Jawon Medical for unrestricted evaluation


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

Christopher E. Clark, Fiona C. Warren, Kate Boddy, Sinead T.J. McDonagh, Sarah F. Moore, John Goddard, Nigel Reed, Malcolm Turner, Maria Teresa Alzamora, Rafel Ramos Blanes, Shao-Yuan Chuang, Michael Criqui, Marie Dahl, Gunnar Engström, Raimund Erbel, Mark Espeland, Luigi Ferrucci, Maëlenn Guerchet, Andrew Hattersley, Carlos Lahoz, Robyn L. McClelland, Mary M. McDermott, Jackie Price, Henri E. Stoffers, Ji-Guang

Wang, Jan Westerink, James White, Lyne Cloutier, Rod S. Taylor, Angela C. Shore, Richard J. McManus, Victor Aboyans, John L. Campbell
Hypertension Dec 21 2020

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Last Updated on December 21, 2020 by Marie Benz MD FAAD