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

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  • Christopher E Clark, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Fiona C Warren, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Kate Boddy, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Sinead T J McDonagh, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Sarah F Moore, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • John Goddard, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Nigel Reed, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Malcolm Turner, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Maria Teresa Alzamora, Unitat de Suport a la Recerca Metropolitana Nord
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  • Rafel Ramos Blanes, University of Girona
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  • Shao-Yuan Chuang, National Health Research Institutes Taiwan
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  • Michael Criqui, University of California
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  • Marie Dahl
  • Gunnar Engström, Lund University
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  • Raimund Erbel, University Hospital Essen
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  • Mark Espeland, Wake Forest School of Medicine
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  • Luigi Ferrucci, National Institute on Aging
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  • Maëlenn Guerchet, Tropical Neuroepidemiology
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  • Andrew Hattersley, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.
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  • Carlos Lahoz, University Hospital La Paz
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  • Robyn L McClelland, University of Washington
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  • Mary M McDermott, Northwestern University Feinberg School of Medicine
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  • Jackie Price, Edinburgh University, Edinburgh
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  • Henri E Stoffers, Maastricht University
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  • Ji-Guang Wang, Shanghai Jiaotong University School of Medicine, Shanghai
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  • Jan Westerink, University Medical Center Utrecht
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  • James White, Cardiff University
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  • Lyne Cloutier, Université du Québec à Trois-Rivières
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  • Rod S Taylor, University of Exeter Medical School, University of Glasgow
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  • Angela C Shore, Royal Devon and Exeter Hospital, University of Exeter
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  • Richard J McManus, University of Oxford
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  • Victor Aboyans, Dupuytren University Hospital, Limoges, France.
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  • John L Campbell, University of Exeter Medical School, University of Exeter, Exeter EX1 2LU, UK.

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.

OriginalsprogEngelsk
TidsskriftHypertension (Dallas, Tex. : 1979)
Vol/bind77
Nummer2
Sider (fra-til)650–661
Antal sider12
ISSN0194-911X
DOI
StatusUdgivet - feb. 2021

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