Difference in blood pressure between arms linked to greater early death
risk

Date:
December 21, 2020
Source:
University of Exeter
Summary:
Robust evidence from a large international study confirms that a
difference in blood pressure readings between arms is linked to
greater risk of heart attack, stroke and death.



FULL STORY ========================================================================== Robust evidence from a large international study confirms that a
difference in blood pressure readings between arms is linked to greater
risk of heart attack, stroke and death.


==========================================================================
Led by the University of Exeter, the global INTERPRESS-IPD Collaboration conducted a meta-analysis of all the available research, then merged data
from 24 global studies to create a database of nearly 54,000 people. The
data spanned adults from Europe, the US, Africa and Asia for whom blood pressure readings for both arms were available.

Funded by the National Institute for Health Research (NIHR) and published
today in Hypertension, the study is the first to conclude that the
greater the inter- arm blood pressure difference, the greater the
patient's additional health risk.

Currently, international blood pressure guidelines advise health
professionals to measure blood pressure in both arms when assessing cardiovascular risk,- yet this is widely ignored. The new study provides
a new upper limit of 'normal' for an inter-arm difference in blood
pressure, which is significantly lower than the current guidance. The
research could lead to a change in international hypertension guidelines, meaning more at-risk patients could be identified and receive potentially life-saving treatment.

In a methodology that put patients at its heart, working with a patient advisory group at every step of the research, the team analysed data on
inter- arm blood pressure difference, and tracked the number of deaths,
heart attacks and strokes that occurred in the cohort over 10 years.

Lead author and GP Dr Chris Clark, of the University of Exeter Medical
School, said: "Checking one arm then the other with a routinely used
blood pressure monitor is cheap and can be carried out in any healthcare setting, without the need for additional or expensive equipment. Whilst international guidelines currently recommend that this is done,
it only happens around half of the time at best, usually due to time constraints. Our research shows that the little extra time it takes to
measure both arms could ultimately save lives." "We've long known that
a difference in blood pressure between the two arms is linked to poorer
health outcomes. The large numbers involved in the INTERPRESS- IPD study
help us to understand this in more detail. It tells us that the higher the difference in blood pressure between arms, the greater the cardiovascular
risk, so it really is critical to measure both arms to establish which
patients may be at significantly increased risk. Patients who require a
blood pressure check should now expect that it's checked in both arms,
at least once." Blood pressure rises and falls in a cycle with each
pulse. It is measured in units of millimetres of mercury (mmHg), and the reading is always given as two numbers: the upper (systolic) reading
represents the maximum blood pressure and the lower (diastolic) value
is the minimum blood pressure. A high systolic blood pressure indicates hypertension. This affects one third of the adult population and is the
single leading cause globally of preventable heart attacks, strokes and
deaths. A significant difference between the systolic blood pressure measurements in the two arms could be indicative of a narrowing, or a stiffening, of the arteries, which can affect blood flow. These arterial changes are recognised as a further risk marker for subsequent heart
attack, stroke or early death, and should be investigated for treatment.

The researchers concluded that each mmHg difference found between the two
arms, elevated predicted 10-year risk of one of the following occurring
by one percent; new angina, a heart attack or stroke.

At the moment, both UK and European guidelines recognise a systolic
difference of 15 mmHg or more between the two arms as the threshold
indicative of additional cardiovascular risk. This new study found
that a lower threshold of 10 mmHg was clearly indicative of additional
risk, which would mean that far more people should be considered for
treatment if such a difference between arms is present. To this end,
the research team has created a tool that is easy for clinicians to use,
to establish who should be considered for treatment based on their risk, incorporating the blood pressure reading in both arms.

Research co-author Professor Victor Aboyans, head of the department of cardiology at the Dupuytren University Hospital in Limoges, France, said
"We believe that a 10 mmHg difference can now reasonably be regarded as
an upper limit of normal for systolic inter-arm blood pressure, when both
arms are measured in sequence during routine clinical appointments. This information should be incorporated into future guidelines and clinical
practice in assessing cardiovascular risk. It would mean many more
people were considered for treatment that could reduce their risk of
heart attack, stroke and death." An interarm difference of greater
than 10 mmHg occurs in 11 per cent of people with high blood pressure (hypertension) -- itself a known health risk -- and in four per cent of
the general population.


========================================================================== Story Source: Materials provided by University_of_Exeter. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Christopher E. Clark, Fiona C. Warren, Kate Boddy, Sinead
T.J. McDonagh,
Sarah F. Moore, John Goddard, Nigel Reed, Malcolm Turner,
Maria Teresa Alzamora, Rafel Ramos Blanes, Shao-Yuan Chuang,
Michael Criqui, Marie Dahl, Gunnar Engstro"m, Raimund Erbel, Mark
Espeland, Luigi Ferrucci, Mae"lenn Guerchet, Andrew Hattersley,
Carlos Lahoz, Robyn L. McClelland, Mary M. McDermott, Jackie
Price, Henri E. Stoffers, Ji-Guang Wang, Jan Westerink, James
White, Lyne Cloutier, Rod S. Taylor, Angela C. Shore, Richard
J. McManus, Victor Aboyans, John L. Campbell. Associations
Between Systolic Interarm Differences in Blood Pressure and
Cardiovascular Disease Outcomes and Mortality. Hypertension, 2020;
DOI: 10.1161/HYPERTENSIONAHA.120.15997 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/12/201221101208.htm

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