Inter-arm Systolic Blood Pressure Difference: A Surrogate for Diagnosis of Peripheral Arterial Disease

Background : Prospective data pertaining to risk factors for peripheral arterial disease (PAD) in women are sparse. Few studies have evaluated blood pressure, including uncontrolled hypertension, and PAD onset in women. Methods and Results : We examined the relationship between blood pressure and development of confirmed symptomatic PAD (n=116 events) in a prospective cohort study of 39,261 female health professionals aged ≤ 45 years without diagnosed vascular disease at baseline. Median follow-up was 11.4 years. Women were first grouped according to baseline presence of uncontrolled hypertension, defined as reported systolic blood pressure (SBP)≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg, and pharmacologic treatment status. SBP and DBP were then modeled as continuous and categorical exposures irrespective of treatment status. Pulse pressure (PP) and mean arterial pressure (MAP) were also assessed. Age-adjusted and multivariable-adjusted risk estimates were derived from Cox proportional hazards models. Women with treated but uncontrolled hypertension had the highest risk of symptomatic PAD (0.67 events per 1000 person-years). Adjusted hazard ratios (HRs) compared to women without hypertension were 1.1 (95% CI, 0.5–2.3) for women who were treated and controlled, 1.7 (95% CI, 1.0 –3.0) for women untreated and uncontrolled, and 2.3 (95% CI, 1.4 – 4.0) for women treated and uncontrolled (p-trend<0.001). When hypertension was examined using continuous and categorical measures, there was a 33% increase in risk per 10 mmHg of SBP (95% CI, 18 to 47%) and a positive gradient in multivariable-adjusted risk according to SBP category (<120, 120 –139, 140 –159, and ≤ 160 mmHg); HRs were 1.0, 1.6, 2.8, and 4.3 (p-trend<0.001), respectively. We also considered DBP, PP, and MAP. While individually predictive, none was a stronger predictor than SBP with none adding predictive ability beyond SBP. Conclusions : Uncontrolled hypertension is associated with incident symptomatic PAD in women. Among blood pressure variables assessed, SBP is the best single predictor. These data support a strong prognostic role for systolic blood pressure in the development of peripheral atherosclerosis in women.

Download Full-text

Role of systolic blood pressure and plasma triglycerides in diabetic peripheral arterial disease. The Edinburgh Artery Study

Diabetes Care ◽

10.2337/diacare.22.3.453 ◽

1999 ◽

Vol 22 (3) ◽

pp. 453-458 ◽

Cited By ~ 44

Author(s):

A. S. MacGregor ◽

J. F. Price ◽

C. M. Hau ◽

A. J. Lee ◽

M. N. Carson ◽

...

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Systolic Blood Pressure ◽

Arterial Disease ◽

Plasma Triglycerides ◽

Peripheral Arterial

Download Full-text

Hyperoxia Exaggerates Systolic Blood Pressure Response in Patients with Peripheral Arterial Disease

The FASEB Journal ◽

10.1096/fasebj.2021.35.s1.03596 ◽

2021 ◽

Vol 35 (S1) ◽

Author(s):

Zhaohui Gao ◽

Jonathon Stavres ◽

Jian Cui ◽

Kristen Brandt ◽

Dani Jin‐Kwang Kim ◽

...

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Systolic Blood Pressure ◽

Blood Pressure Response ◽

Arterial Disease ◽

Pressure Response ◽

Peripheral Arterial

Download Full-text

Interarm Difference in Blood Pressure: Reproducibility and Association with Peripheral Vascular Disease

International Journal of Vascular Medicine ◽

10.1155/2014/841542 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jesper Mehlsen ◽

Niels Wiinberg

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Systolic Blood Pressure ◽

Arterial Disease ◽

Peripheral Vascular ◽

Vascular Laboratory ◽

Insignificant Difference ◽

Peripheral Arterial ◽

The Right ◽

Diagnosis Of Hypertension

The present study aimed at examining the interarm difference in blood pressure and its use as an indicator of peripheral arterial disease (PAD). Data were included from consecutive patients referred from their general practitioner to our vascular laboratory for possible PAD aged 50 years or older without known cardiac disease, renal disease, or diabetes mellitus. 824 patients (453 women) with mean age of 72 years (range: 50–101) were included. 491 patients had a diagnosis of hypertension and peripheral arterial disease (PAD) was present in 386 patients. Systolic blood pressure was 143 ± 24 mmHg and 142 ± 24 mmHg on the right and left arm, respectively (P=0.015). The interarm difference was greater in patients with hypertension (P=0.002) and PAD (P<0.0005). 443 patients were measured on two separate occasions and the interarm difference for systolic blood pressure was reproducible for differences >20 mmHg. This study confirmed the presence of a systematic but clinically insignificant difference in systolic blood pressure between arms. The interarm difference was larger in hypertension and PAD. Consistent lateralisation is present for differences ≥20 mmHg and an interarm difference >25 mmHg is a reliable indicator of PAD in the legs.

Download Full-text

INTERARM BLOOD PRESSURE

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.09.1702 ◽

2016 ◽

Vol 23 (09) ◽

pp. 1079-1083

Author(s):

Ahmad Faraz ◽

Ujala Zubair ◽

Usama Khalid Choudry ◽

Iram Aamir Siddiqa ◽

Ushna Naeem ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Pressure Difference ◽

Vascular Medicine ◽

Vascular Events ◽

New Era ◽

Blood Pressure Difference ◽

Regular Measurement ◽

Peripheral Arterial

Interarm blood pressure difference is linked to various peripheral arterial diseaseand thus occupies great significance in vascular medicine. Due to various physiological&pathological changes vessels suffer with hardening that produces measurable inter armblood pressure difference. Less than one in 5 physicians is interested in measuring bloodpressure in both arms. Objectives: to study the interarm blood pressure difference amongmedical students and its association with age, gender, BMI. Study Design: Cross-sectionalstudy. Setting: Karachi. Period: September 2015 to November 2015. Methodology: Data wascollected from 305 individuals, Blood pressure was measured by designated technician withstudents in sitting position with at least 5 minutes of rest, among healthy nonsmokers medicalstudents of DUHS. Results: Mean weight of individuals was 57.4+- 12.9 kg. Mean height wasfound to be 164.6+-9.5 mm of Hg. Mean BMI of individuals was 21.0 +-3.78 kg/m2. Mean rightarm systolic blood pressure was found to be 102.9+-13.4 mm of Hg. Mean right arm diastolicpressure was found to be 64.1+-12.8 mm of Hg. Mean left arm systolic blood pressure wasfound to be 101.8 +-13.0 mm of Hg. Mean left arm diastolic blood pressure was found tobe 64.4+-12.9 mm of Hg. Mean interarm systolic blood pressure was found to be 7.4+-7.6mm of Hg. Mean interarm diastolic blood pressure difference was found to be 8.6+-8.5 mmof Hg. Conclusions: Regular measurement of blood pressure in both arms and assessmentof interarm blood pressure difference can lead to a new era where vascular events can bediagnosed at an earlier stage and thus treated earlier

Download Full-text

INTERARM SYSTOLIC BLOOD PRESSURE DIFFERENCE IS ASSOCIATED WITH A HIGH PREVALENCE OF CARDIO VASCULAR DISEASES- A CROSS-SECTIONAL STUDY IN POLICE WORKER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i11.1524 ◽

2020 ◽

Vol 4 (11) ◽

Author(s):

Somesh Raju ◽

Rina Kumari ◽

Sunita Tiwari ◽

NS Verma

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Blood Sugar ◽

Pressure Difference ◽

Systolic Pressure ◽

Working Environment ◽

Vascular Events ◽

Cross Sectional ◽

Blood Pressure Difference ◽

High Prevalence

Background: Interarm systolic blood pressure difference more than 10 mm of Hg is predictor of cardiovascular and metabolic risk. Despite of sufficient physical activity there is high prevalence of obesity in police personal because of stressful working environment. No studies have addressed the significance of interarm pressure difference among them. Therefore, the present study conducted to access the relation of interarm blood pressure difference with obesity in police personnel. Aims and Objective: To estimate the interarm pressure difference in police personal to see its association with their obesity. Material and Method: This cross-sectional observational study done on 245 police workers in PAC, Sitapur, India. Subjects having more than ten years of working experience were included in study. Anthropometric measurements of subject recorded by following standard protocol. Measurement of systolic pressure in both arm recorded simultaneously by mercury sphygmomanometer. Available data analyze and expressed in percentage, mean with SD and chi square test to see the significance of association. Results: According to anthropometric results of subjects 77.14 prcent subjects were having generalised obesity and 82.04 percent of subjects having abdominal obesity. 34.29 percent of subjects showed abnormally high (?10 mmHg) inter-arm systolic blood pressure difference. Both type of obesity showed positive association with blood sugar level but no association with interarm pressure difference. Conclusion: Interarm blood pressure difference is greater in individual having obesity or prolong duration of service. Such subjects are more susceptible to develop coronary artery disease or peripheral arterial disease in future. Early screening can help to detect the vascular events likely to occur in the future Keywords: Body mass index, Waist circumference, Interarm pressure difference, Random blood sugar

Download Full-text

Association between an elevated inter-arm systolic blood pressure difference, the ankle–brachial index, and mortality in patients with diabetes mellitus

Clínica e Investigación en Arteriosclerosis ◽

10.1016/j.arteri.2019.11.003 ◽

2020 ◽

Vol 32 (3) ◽

pp. 94-100

Author(s):

Javier Ena ◽

Santiago Pérez-Martín ◽

Carlos R. Argente ◽

Teresa Lozano

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Pressure Difference ◽

Ankle Brachial Index ◽

Blood Pressure Difference ◽

Patients With Diabetes

Download Full-text

Saving more lives and limbs: applying a cardiac rehabilitation model of structured exercise to symptomatic peripheral arterial disease

British Journal of Cardiac Nursing ◽

10.12968/bjca.2020.0086 ◽

2021 ◽

pp. 1-8

Author(s):

Susan Matthews ◽

Martin Fox ◽

Sarah Coy ◽

Jane Whittaker ◽

Gail Brough ◽

...

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Peripheral Arterial Disease ◽

Cardiac Rehabilitation ◽

Intermittent Claudication ◽

Arterial Disease ◽

Morbidity And Mortality ◽

Supervised Exercise ◽

Peripheral Arterial

Background/Aims Peripheral arterial disease is common among those aged 60 years or above and can cause debilitating intermittent claudication. This impacts quality of life and is a marker for increased morbidity and mortality, mainly from cardiovascular disease. Access to recommended exercise programmes for people with symptomatic peripheral arterial disease is poor in most areas of the UK. This study aimed to evaluate the benefits of expanding an established cardiac rehabilitation service to accommodate supervised exercise for people with peripheral arterial disease Methods The study evaluated 11 participants peripheral arterial disease and intermittent claudication who were referred by the Manchester leg circulation service. Participants underwent the programme involving eight weekly 1.5 hour sessions of supervised exercise and cardiovascular education with support, reassurance and motivation. The participants' blood pressure, walking impairment, quality of life, anxiety and depression were monitored and reviewed. Results Overall, the participants' walking distance, intermittent claudication, quality of life and blood pressure had improved. The participants' overall satisfaction with the programme was excellent. The programme also demonstrated clinical and cost-effectiveness. Conclusions A structured, supervised exercise programme can have considerable benefits for people with peripheral arterial disease, improving their symptoms and quality of life. It may also help to reduce the morbidity and mortality risks associated with inactivity in this patient group.

Download Full-text