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Open Access 01-12-2024 | Research

Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult’s Cohort Study (FACS)

Authors: Ali Mouseli, Mehdi Sharafi, Zahra Amiri, Azizallah Dehghan, Elham Haghjoo, Mohammad Ali Mohsenpour, Mohammad Hassan Eftekhari, Hossein Fatemian, Omid Keshavarzian

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

One of the modifiable risk factors for cardiovascular diseases is the inter-arm blood pressure difference (IAD), which can be easily measured. This study aimed to determine the prevalence and factors related to the Iranian population’s inter-arm differences in systolic and diastolic blood pressure.

Method

This cross-sectional study was conducted on the baseline data of participants who had Iranian nationality, were at least 1 year of residence in the area, aged within the age range of 35–70 years, and willed to participate from the Fasa Persian Adult Cohort Study (FACS). IAD for systolic and diastolic blood pressure was measured and categorized into two groups of difference < 10 and ≥ 10 mmHg. Logistic regression was used to model the association between independent variables and IAD.

Results

The prevalence of systolic and diastolic IAD ≥ 10 mmHg was 16.34% and 10.2%, respectively, among 10,124 participants. According to the multivariable logistic regression models, age (adjusted odds ratio (aOR): 1.019 [95% CI: 1.013, 1.025]), body mass index (BMI) (aOR: 1.112 [95% CI: 1.016, 1.229]), having type 2 diabetes (aOR _Yes/No: 1.172 [95% CI: 1.015, 1.368]), having chronic headaches (aOR _Yes/No: 1.182 [95% CI: 1.024, 1.365]), and pulse rate (aOR: 1.019 [95% CI: 1.014, 1.024]) significantly increased the odds of systolic IAD ≥ 10 mmHg. Additionally, high socio-economic status decreased the odds of systolic IAD ≥ 10 mmHg (aOR _High/Low: 0.854 [95% CI: 0.744, 0.979]). For diastolic IAD, age (aOR: 1.112 [95% CI: 1.015, 1.210]) and pulse rate (aOR: 1.021 [95% CI: 1.015, 1.027]) significantly increased the odds of diastolic IAD ≥ 10 mmHg. Moreover, high socioeconomic status decreased the odds of diastolic IAD ≥ 10 mmHg (aOR _High/Low: 0.820 [95% CI: 0.698, 0.963]).

Conclusion

The noticeable prevalence of systolic and diastolic IAD in general population exhibits health implications due to its’ association with the risk of cardiovascular events. Sociodemographic and medical history assessments have potentials to be incorporated in IAD risk stratification and preventing programs.

Mahase E. Cancer overtakes CVD to become the leading cause of death in high income countries. BMJ: Br Med J (Online). 2019;366.

Zeng Z, Chen J, Xiao C, Chen W. A global view on prevalence of hypertension and human develop index. Annals of Global Health. 2020;86(1).

Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37.CrossRefPubMedPubMedCentral

Zhou M, Gao Z, Chen F, Xu H, Dong X, Ma L. The inter-arm systolic blood pressure difference and risk of cardiovascular mortality: a meta-analysis of cohort studies. Clin Exp Hypertens. 2016;38(3):317–24.CrossRefPubMed

Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34(5):506–25.CrossRefPubMed

Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines. J Am Coll Cardiol. 2017;71(6):1269–324.

Mejzner N, Clark CE, Smith LF, Campbell JL. Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England. Br J Gen Pract. 2017;67(658):e306–e13.CrossRefPubMedPubMedCentral

Stevens SL, McManus RJ, Stevens RJ. Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’study in UK primary care. BMJ open. 2018;8(4):e020589.CrossRefPubMedPubMedCentral

Poon L, Kametas N, Strobl I, Pachoumi C, Nicolaides K. Inter-arm blood pressure differences in pregnant women. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(9):1122–30.CrossRef

10.

Clark CE, Campbell JL, Evans PH, Millward A. Prevalence and clinical implications of the inter–arm blood pressure difference: a systematic review. J Hum Hypertens. 2006;20(12):923–31.CrossRefPubMed

11.

Clark CE, Warren FC, Boddy K, McDonagh ST, Moore SF, Goddard J, et al. 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. Hypertension. 2021;77(2):650–61.CrossRefPubMed

12.

Sharafi M, Amiri Z, Haghjoo E, Afrashteh S, Dastmanesh S, Moghaddam MT, et al. Association between inter-arm blood pressure difference and cardiovascular disease: result from baseline Fasa adults Cohort Study. Sci Rep. 2023;13(1):9648.CrossRefPubMedPubMedCentralADS

13.

Essa RA, Ahmed SK. Prevalence of inter-arm blood pressure difference among young healthy adults: results from a large cross-sectional study on 3235 participants. Annals of Medicine and Surgery. 2022;77:103631.CrossRefPubMedPubMedCentral

14.

Clark CE, Taylor RS, Shore AC, Campbell JL. Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis. Br J Gen Pract. 2016;66(652):e838–47.CrossRefPubMedPubMedCentral

15.

Verberk WJ, Kessels AG, Thien T. Blood pressure measurement method and inter-arm differences: a meta-analysis. Am J Hypertens. 2011;24(11):1201–8.CrossRefPubMed

16.

Beevers G, Lip GY, O’Brien E. Blood pressure measurement: part II—Conventional sphygmomanometry: technique of auscultatory blood pressure measurement. BMJ. 2001;322(7293):1043–7.PubMedPubMedCentral

17.

Clark CE, Steele AM, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Interarm blood pressure difference in people with diabetes: measurement and vascular and mortality implications: a cohort study. Diabetes Care. 2014;37(6):1613–20.CrossRefPubMed

18.

Clark CE, Taylor RS, Shore AC, Campbell JL. The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ. 2012;344.

19.

Kim J, Song T-J, Song D, Lee HS, Nam CM, Nam HS, et al. Interarm blood pressure difference and mortality in patients with acute ischemic stroke. Neurology. 2013;80(16):1457–64.CrossRefPubMed

20.

Homayounfar R, Farjam M, Bahramali E, Sharafi M, Poustchi H, Malekzadeh R et al. Cohort Profile: the Fasa adults Cohort Study (FACS): a prospective study of non-communicable diseases risks. Int J Epidemiol. 2023.

21.

Clark CE, Taylor RS, Butcher I, Stewart MC, Price J, Fowkes FGR, et al. Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk. Br J Gen Pract. 2016;66(646):e297–e308.CrossRefPubMedPubMedCentral

22.

Kimura A, Hashimoto J, Watabe D, Takahashi H, Ohkubo T, Kikuya M, et al. Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan. J Hypertens. 2004;22(12):2277–83.CrossRefPubMed

23.

Johansson JK, Puukka PJ, Jula AM. Interarm blood pressure difference and target organ damage in the general population. J Hypertens. 2014;32(2):260–6.CrossRefPubMed

24.

Weinberg I, Gona P, O’Donnell CJ, Jaff MR, Murabito JM. The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study. Am J Med. 2014;127(3):209–15.CrossRefPubMed

25.

Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–57.CrossRefPubMed

26.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.CrossRefPubMed

27.

Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. The Lancet. 2012;379(9819):905–14.CrossRef

28.

Rosenberger J, McCrudden S, McCullough C, Wang L, Kime J, Albert NM. Factors associated with inter-arm blood pressure differences in patients admitted to critical care units. Heart & Lung. 2018;47(2):100–6.CrossRef

29.

Gbaguidi GN, Kaboure A, Houehanou YC, Amidou SA, Houinato DS, Aboyans V, et al. Inter-arm difference in systolic blood pressure: prevalence and associated factors in an African population. PLoS ONE. 2022;17(8):e0272619.CrossRefPubMedPubMedCentral

30.

Kranenburg G, Spiering W, de Jong PA, Kappelle LJ, de Borst GJ, Cramer MJ, et al. Inter-arm systolic blood pressure differences, relations with future vascular events and mortality in patients with and without manifest vascular disease. Int J Cardiol. 2017;244:271–6.CrossRefPubMed

31.

Miyashima M, Shoji T, Kakutani Y, Yamazaki Y, Ochi A, Morioka T, et al. Inter-arm blood pressure difference in diabetes mellitus and its preferential association with peripheral artery disease. J Atheroscler Thromb. 2020;27(8):780–8.CrossRefPubMedPubMedCentral

32.

Lane D, Beevers M, Barnes N, Bourne J, John A, Malins S, et al. Inter-arm differences in blood pressure: when are they clinically significant? J Hypertens. 2002;20(6):1089–95.CrossRefPubMed

33.

Gopalakrishnan S, Savitha AK, Rama R. Evaluation of inter-arm difference in blood pressure as predictor of vascular diseases among urban adults in Kancheepuram District of Tamil Nadu. J Family Med Prim Care. 2018;7(1):142–6.CrossRefPubMedPubMedCentral

34.

White J, Mortensen LH, Kivimäki M, Gale CR, Batty GD. Interarm differences in systolic blood pressure and mortality among US army veterans: aetiological associations and risk prediction in the Vietnam experience study. Eur J Prev Cardiol. 2014;21:1394–400.CrossRefPubMedPubMedCentral

35.

Tokitsu T, Yamamoto E, Hirata Y, Fujisue K, Sugamura K, Maeda H, et al. Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease. J Hypertens. 2015;33(9):1780–9.CrossRefPubMed

36.

Sun L, Zou T, Wang BZ, Liu F, Yuan QH, Ma YT, et al. Epidemiological investigation into the prevalence of abnormal inter-arm blood pressure differences among different ethnicities in Xinjiang, China. PLoS ONE. 2018;13(1):e0188546.CrossRefPubMedPubMedCentral

37.

Song BM, Kim HC, Shim JS, Lee MH, Choi DP. Inter–arm difference in brachial blood pressure in the general population of koreans. Korean Circ J. 2016;46:374–83.CrossRefPubMedPubMedCentral

Title: Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult’s Cohort Study (FACS)
Authors: Ali Mouseli
Mehdi Sharafi
Zahra Amiri
Azizallah Dehghan
Elham Haghjoo
Mohammad Ali Mohsenpour
Mohammad Hassan Eftekhari
Hossein Fatemian
Omid Keshavarzian
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17857-8

Keynote webinar | Spotlight on medication adherence

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Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult’s Cohort Study (FACS)

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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