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- Title
Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk.
- Authors
Clark, Christopher E.; Taylor, Rod S.; Butcher, Isabella; Stewart, Marlene C. W.; Price, Jackie; R. Fowkes, F. Gerald; Shore, Angela C.; Campbell, John L.; Stewart, Marlene Cw; Fowkes, F Gerald R
- Abstract
<bold>Background: </bold>Differences in blood pressure between arms are associated with increased cardiovascular mortality in cohorts with established vascular disease or substantially elevated cardiovascular risk.<bold>Aim: </bold>To explore the association of inter-arm difference (IAD) with mortality in a community-dwelling cohort that is free of cardiovascular disease.<bold>Design and Setting: </bold>Cohort analysis of a randomised controlled trial in central Scotland, from April 1998 to October 2008.<bold>Method: </bold>Volunteers from Lanarkshire, Glasgow, and Edinburgh, free of pre-existing vascular disease and with an ankle-brachial index ≤0.95, had systolic blood pressure measured in both arms at recruitment. Inter-arm blood pressure differences were calculated and examined for cross-sectional associations and differences in prospective survival. Outcome measures were cardiovascular events and all-cause mortality during mean follow-up of 8.2 years.<bold>Results: </bold>Based on a single pair of measurements, 60% of 3350 participants had a systolic IAD ≥5 mmHg and 38% ≥10 mmHg. An IAD ≥5 mmHg was associated with increased cardiovascular mortality (adjusted hazard ratio [HR] 1.91, 95% confidence interval [CI] = 1.19 to 3.07) and all-cause mortality (adjusted HR 1.44, 95% CI = 1.15 to 1.79). Within the subgroup of 764 participants who had hypertension, IADs of ≥5 mmHg or ≥10 mmHg were associated with both cardiovascular mortality (adjusted HR 2.63, 95% CI = 0.97 to 7.02, and adjusted HR 2.96, 95% CI = 1.27 to 6.88, respectively) and all-cause mortality (adjusted HR 1.67, 95% CI = 1.05 to 2.66, and adjusted HR 1.63, 95% CI = 1.06 to 2.50, respectively). IADs ≥15 mmHg were not associated with survival differences in this population.<bold>Conclusion: </bold>Systolic IADs in blood pressure are associated with increased risk of cardiovascular events, including mortality, in a large cohort of people free of pre-existing vascular disease.
- Subjects
CARDIOVASCULAR disease related mortality; COHORT analysis; BLOOD pressure measurement; PRIMARY care; VASCULAR diseases; RANDOMIZED controlled trials
- Publication
British Journal of General Practice, 2016, Vol 66, Issue 646, pe297
- ISSN
0960-1643
- Publication type
journal article
- DOI
10.3399/bjgp16X684949