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Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk.
- Source :
-
The British journal of general practice : the journal of the Royal College of General Practitioners [Br J Gen Pract] 2016 May; Vol. 66 (646), pp. e297-308. Date of Electronic Publication: 2016 Apr 14. - Publication Year :
- 2016
-
Abstract
- Background: Differences in blood pressure between arms are associated with increased cardiovascular mortality in cohorts with established vascular disease or substantially elevated cardiovascular risk.<br />Aim: To explore the association of inter-arm difference (IAD) with mortality in a community-dwelling cohort that is free of cardiovascular disease.<br />Design and Setting: Cohort analysis of a randomised controlled trial in central Scotland, from April 1998 to October 2008.<br />Method: 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.<br />Results: 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.<br />Conclusion: 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.<br /> (© British Journal of General Practice 2016.)
- Subjects :
- Aspirin therapeutic use
Body Mass Index
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Hypertension complications
Hypertension mortality
Male
Middle Aged
Peripheral Vascular Diseases mortality
Peripheral Vascular Diseases physiopathology
Platelet Aggregation Inhibitors therapeutic use
Population Surveillance
Risk Factors
Scotland epidemiology
Arm blood supply
Blood Pressure physiology
Blood Pressure Determination methods
Hypertension diagnosis
Peripheral Vascular Diseases diagnosis
Primary Health Care
Subjects
Details
- Language :
- English
- ISSN :
- 1478-5242
- Volume :
- 66
- Issue :
- 646
- Database :
- MEDLINE
- Journal :
- The British journal of general practice : the journal of the Royal College of General Practitioners
- Publication Type :
- Academic Journal
- Accession number :
- 27080315
- Full Text :
- https://doi.org/10.3399/bjgp16X684949