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Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality : Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration

Clark, Christopher E. ; Warren, Fiona C. ; Boddy, Kate ; McDonagh, Sinead T.J. ; Moore, Sarah F. ; Goddard, John ; Reed, Nigel ; Turner, Malcolm ; Alzamora, Maria Teresa and Ramos Blanes, Rafel , et al. (2021) In Hypertension 77(2). p.650-661
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
blood pressure, cardiovascular disease, meta-analysis, mortality, risk
in
Hypertension
volume
77
issue
2
pages
12 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85100070460
  • pmid:33342236
ISSN
1524-4563
DOI
10.1161/HYPERTENSIONAHA.120.15997
language
English
LU publication?
yes
id
f8d4c6ff-dfc7-4605-ab04-98280a1c65eb
date added to LUP
2021-02-05 14:03:39
date last changed
2022-08-11 20:12:17
@article{f8d4c6ff-dfc7-4605-ab04-98280a1c65eb,
  abstract     = {{<p>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.</p>}},
  author       = {{Clark, Christopher E. and Warren, Fiona C. and Boddy, Kate and McDonagh, Sinead T.J. and Moore, Sarah F. and Goddard, John and Reed, Nigel and Turner, Malcolm and Alzamora, Maria Teresa and Ramos Blanes, Rafel and Chuang, Shao Yuan and Criqui, Michael and Dahl, Marie and Engström, Gunnar and Erbel, Raimund and Espeland, Mark and Ferrucci, Luigi and Guerchet, Maëlenn and Hattersley, Andrew and Lahoz, Carlos and McClelland, Robyn L. and McDermott, Mary M. and Price, Jackie and Stoffers, Henri E. and Wang, Ji Guang and Westerink, Jan and White, James and Cloutier, Lyne and Taylor, Rod S. and Shore, Angela C. and McManus, Richard J. and Aboyans, Victor and Campbell, John L.}},
  issn         = {{1524-4563}},
  keywords     = {{blood pressure; cardiovascular disease; meta-analysis; mortality; risk}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{650--661}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Hypertension}},
  title        = {{Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality : Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration}},
  url          = {{http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.15997}},
  doi          = {{10.1161/HYPERTENSIONAHA.120.15997}},
  volume       = {{77}},
  year         = {{2021}},
}