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 IJCM  Vol.7 No.5 , May 2016
Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index
Abstract: Background: In new outpatients, blood pressure should be measured in both arms. A previous study reported that an inter-arm systolic blood pressure difference (ΔSBP) of ≥10 mm Hg is associated with an increased risk of mortality. Aim: The aim was to identify the associations with absolute values of ΔSBP (|ΔSBP|) ≥10 mm Hg. Subjects and Methods: This study included 2481 patients. Patients with a body mass index ≥25 kg/m2 were defined as obese. The group of A was defined as following: ankle-brachial index (ABI) was <0.9 or ≥1.3. ΔSBP was expressed as right arm BP minus left arm BP. |ΔSBP| ≥10 mm Hg were analyzed using multivariate logistic analysis. Results: |ΔSBP| ≥10 mm Hg was found in 6.0% of patients and |ΔSBP| < 5 mm Hg in 80.4%. In multivariate analysis, the odds ratios (ORs) of the associations with |ΔSBP| ≥10 mm Hg were significantly associated with abnormal ABI and obesity regardless of sex and age. Moreover, the OR of the combined effects of abnormal ABI and obesity was higher than that of abnormal ABI and obesity alone. Conclusion: |ΔSBP| ≥10 mm Hg was associated with abnormal ABI and obesity. In a primary care setting, blood pressure should be actively measured in both arms. This study suggests that the associations with |ΔSBP| ≥10 mm Hg may be a useful part of screening for abnormal ABI.
Cite this paper: Maeda, S. , Okumura, Y. , Hara, N. , (2016) Association between Systolic Blood Pressure Difference ≥10 mm Hg and Ankle-Brachial Index. International Journal of Clinical Medicine, 7, 361-369. doi: 10.4236/ijcm.2016.75039.
References

[1]   Kimura, A., Hashimoto, J., Watabe, D., Takahashi, H., Ohkubo, T., Kikuya, M., et al. (2004) Patient Characteristics and Factors Associated with Inter-Arm Difference of Blood Pressure Measurements in a General Population in Ohasama, Japan. Journal of Hypertension, 22, 2277-2283.
http://dx.doi.org/10.1097/00004872-200412000-00009

[2]   Kleefstra, N., Houweling, S.T., Logtenberg, S.J. and Bilo, H.J. (2008) Prognostic Significance of Between-Arm Blood Pressure Differences: Between-Arm Blood Pressure Difference and Mortality. Hypertension, 51, 657-662.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.104943

[3]   Lee, S.W., Hai, J.J., Kong, S.L., Lam, Y.M., Lam, S., Chan, P.H., et al. (2011) Side Differences of Carotid Intima-Media Thickness in Predicting Cardiovascular Events among Patients with Coronary Artery Disease. Angiology, 62, 231-236.
http://dx.doi.org/10.1177/0003319710379109

[4]   Bots, M.L., de Jong, P.T., Hofman, A. and Grobbee, D.E. (1997) Left, Right, Near or Far Wall Common Carotid Intima-Media Thickness Measurements: Associations with Cardiovascular Disease and Lower Extremity Arterial Atherosclerosis. Journal of Clinical Epidemiology, 50, 801-807.
http://dx.doi.org/10.1016/S0895-4356(97)00059-0

[5]   Clark, C.E., Campbell, J.L., Powell, R.J. and Thompson, J.F. (2007) The Inter-Arm Blood Pressure Difference and Peripheral Vascular Disease: Cross-Sectional Study. Family Practice, 24, 420-426.
http://dx.doi.org/10.1093/fampra/cmm035

[6]   Orme, S., Ralph, S.G., Birchall, A., Lawson-Matthew, P., McLean, K. and Channer, K.S. (1999) The Normal Range for Inter-Arm Differences in Blood Pressure. Age Ageing, 28, 537-542.
http://dx.doi.org/10.1093/ageing/28.6.537

[7]   Eguchi, K., Yacoub, M., Jhalani, J., Gerin, W., Schwartz, J.E. and Pickering, T.G. (2007) Consistency of Blood Pressure Differences between the Left and Right Arms. Archives of Internal Medicine, 167, 388-393.
http://dx.doi.org/10.1001/archinte.167.4.388

[8]   Lane, D., Beevers, M., Barnes, N., Bourne, J., John, A., Malins, S., et al. (2002) Inter-Arm Differences in Blood Pressure: When Are They Clinically Significant? Journal of Hypertension, 20, 1089-1095.
http://dx.doi.org/10.1097/00004872-200206000-00019

[9]   Clark, C.E., Taylor, R.S., Shore, A.C., Ukoumunne, O.C. and Campbell, J.L. (2012) Association of a Difference in Systolic Blood Pressure between Arms with Vascular Disease and Mortality: A Systematic Review and Meta-Analysis. Lancet, 379, 905-914.
http://dx.doi.org/10.1016/S0140-6736(11)61710-8

[10]   Pesola, G.R., Pesola, H.R., Lin, M., Nelson, M.J. and Westfal, R.E. (2002) The Normal Difference in Bilateral Indirect Blood Pressure Recordings in Hypertensive Individuals. Academic Emergency Medicine, 9, 342-345.
http://dx.doi.org/10.1111/j.1553-2712.2002.tb01333.x

[11]   Criqui, M.H., Denenberg, J.O., Bird, C.E., Fronek, A., Klauber, M.R. and Langer, R.D. (1996) The Correlation between Symptoms and Non-Invasive Test Results in Patients Referred for Peripheral Arterial Disease Testing. Vascular Medicine, 1, 65-71.

[12]   Orchard, T.J. and Strandness Jr., D.E. (1993) Assessment of Peripheral Vascular Disease in Diabetes. Report and Recommendations of an International Workshop Sponsored by the American Heart Association and the American Diabetes Association 18-20 September 1992, New Orleans, Louisiana. Diabetes Care, 16, 1199-1209.
http://dx.doi.org/10.2337/diacare.16.8.1199

[13]   Ohnishi, H., Sawayama, Y., Furusyo, N., Maeda, S., Tokunaga, S. and Hayashi, J. (2010) Risk Factors for and the Prevalence of Peripheral Arterial Disease and Its Relationship to Carotid Atherosclerosis: The Kyushu and Okinawa Population Study (KOPS). Journal of Atherosclerosis and Thrombosis, 17, 751-758.
http://dx.doi.org/10.5551/jat.3731

[14]   Williams, B., Lacy, P.S., Thom, S.M., Cruickshank, K., Stanton, A., Collier, D., et al., CAFE Investigators (2006) Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation, 113, 1213-1225.
http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595496

[15]   Luo, X., Yang, Y., Cao, T. and Li, Z. (2011) Differences in Left and Right Carotid Intima-Media Thickness and the Associated Risk Factors. Clinical Radiology, 66, 393-398.
http://dx.doi.org/10.1016/j.crad.2010.12.002

[16]   Rosfors, S., Hallerstam, S., Jensen-Urstad, K., Zetterling, M. and Carlström, C. (1998) Relationship between Intima-Media Thickness in the Common Carotid Artery and Atherosclerosis in the Carotid Bifurcation. Stroke, 29, 1378-1382.
http://dx.doi.org/10.1161/01.STR.29.7.1378

[17]   Clark, C.E., Campbell, J.L., Evans, P.H. and Millward, A. (2006) Prevalence and Clinical Implications of the Inter-Arm Blood Pressure Difference: A Systematic Review. Journal of Human Hypertension, 20, 923-931.
http://dx.doi.org/10.1038/sj.jhh.1002093

[18]   Kim, S.S., Cheong, S.H., Lee, W.J., Jun, D.H., Ko, M.J., Cho, K.R., et al. (2010) Inter-Arm Arterial Pressure Difference Caused by Prone Position in the Thoracic Outlet Syndrome Patient—A Case Report. Korean Journal of Anesthesiology, 58, 91-94.
http://dx.doi.org/10.4097/kjae.2010.58.1.91

[19]   Inoue, S. (2004) Thoracic Outlet Syndrome and Anaesthetic Problems. Acta Anaesthesiologica Scandinavica, 48, 136.
http://dx.doi.org/10.1111/j.1399-6576.2004.0262b.x

[20]   Clark, C.E. and Powell, R.J. (2002) The Differential Blood Pressure Sign in General Practice: Prevalence and Prognostic Value. Family Practice, 19, 439-441.
http://dx.doi.org/10.1093/fampra/19.5.439

[21]   Verberk, W.J., Kessels, A.G. and Thien, T. (2011) Blood Pressure Measurement Method and Inter-Arm Differences: A Meta-Analysis. American Journal of Hypertensions, 24, 1201-1208.
http://dx.doi.org/10.1038/ajh.2011.125

[22]   Examination Committee of Criteria for ‘Obesity Disease’ in Japan, Japan Society for the Study of Obesity. (2002) New Criteria for ‘Obesity Disease’ in Japan. Circulation Journal, 66, 987-992.
http://dx.doi.org/10.1253/circj.66.987

[23]   Unno, M., Furusyo, N., Mukae, H., Koga, T., Eiraku, K. and Hayashi, J. (2012) The Utility of Visceral Fat Level by Bioelectrical Impedance Analysis in the Screening of Metabolic Syndrome. Journal of Atherosclerosis and Thrombosis, 19, 462-470.
http://dx.doi.org/10.5551/jat.11528

[24]   Okauchi, Y., Kishida, K., Funahashi, T., Noguchi, M., Ogawa, T., Ryo, M., et al. (2010) Absolute Value of Bioelectrical Impedance Analysis-Measured Visceral Fat Area with Obesity-Related Cardiovascular Risk Factors in Japanese Workers. Journal of Atherosclerosis and Thrombosis, 17, 1237-1245.
http://dx.doi.org/10.5551/jat.5694

[25]   Yonemoto, K., Doi, Y., Hata, J., Ninomiya, T., Fukuhara, M., Ikeda, F., et al. (2011) Body Mass Index and Stroke Incidence in a Japanese Community: The Hisayama Study. Hypertension Research, 34, 274-279.
http://dx.doi.org/10.1038/hr.2010.220

[26]   Ogihara, T., Kikuchi, K., Matsuoka, H., et al., Japanese Society of Hypertension Committee (2009) The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertension Research, 32, 3-107.

[27]   Mancia, G. and Grassi, G. (2008) The New European Society of Hypertension/European Society of Cardiology (ESH/ESC) Guidelines. Therapeutic Advances in Cardiovascular Disease, 2, 5-12.
http://dx.doi.org/10.1177/1753944707087409

[28]   Pickering, T.G., Hall, J.E., Appel, L.J., et al. (2005) Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation, 111, 697-716.
http://dx.doi.org/10.1161/01.CIR.0000154900.76284.F6

[29]   Shinji, M. (2013) A Study of the Association with Blood Pressure Difference Causing Body Temperature ≥37.5°C and Hypertension in Department of Primary Care. Clinical Physiology and Functional Imaging, 33, 441-449.
http://dx.doi.org/10.1111/cpf.12050

[30]   Puato, M., Palatini, P., Zanardo, M., Dorigatti, F., Tirrito, C., Rattazzi, M. and Pauletto, P. (2008) Increase in Carotid Intima-Media Thickness in Grade I Hypertensive Subjects: White-Coat versus Sustained Hypertension. Hypertension, 51, 1300-1305.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.106773

[31]   Yamagishi, T., Kato, M., Koiwa, Y., Hasegawa, H. and Kanai, H. (2009) Impact of Lifestyle-Related Diseases on Carotid Arterial Wall Elasticity as Evaluated by an Ultrasonic Phased-Tracking Method in Japanese Subjects. Journal of Atherosclerosis and Thrombosis, 16, 782-791.
http://dx.doi.org/10.5551/jat.760

[32]   Sabour, S., Franx, A., Rutten, A., Grobbee, D.E., Prokop, M., Bartelink, M.L., et al. (2007) High Blood Pressure in Pregnancy and Coronary Calcification. Hypertension, 49, 813-817.
http://dx.doi.org/10.1161/01.HYP.0000258595.09320.eb

[33]   Van den Bouwhuijsen, Q.J., Vernooij, M.W., Hofman, A., Krestin, G.P., van der Lugt, A. and Witteman, J.C. (2012) Determinants of Magnetic Resonance Imaging Detected Carotid Plaque Components: The Rotterdam Study. European Heart Journal, 33, 221-229.
http://dx.doi.org/10.1093/eurheartj/ehr227

[34]   Maeda, S., Sawayama, Y., Furusyo, N., Shigematsu, M. and Hayashi, J. (2009) The Association between Fatal Vascular Events and Risk Factors for Carotid Atherosclerosis in Patients on Maintenance Hemodialysis: Plaque Number of Dialytic Atherosclerosis Study. Atherosclerosis, 204, 549-555.
http://dx.doi.org/10.1016/j.atherosclerosis.2008.09.028

[35]   Maeda, S. (2013) Blood Pressure Differences between Arms and Association of Dominant Hands with Blood Pressure Differences and Carotid Atherosclerosis. Blood Pressure Monitoring, 18, 133-137.
http://dx.doi.org/10.1097/MBP.0b013e32836175e3

[36]   Arbel, Y., Maharshak, N., Gal-Oz, A., Shapira, I., Berliner, S. and Bornstein, N.M. (2007) Lack of Difference in the Intimal Medial Thickness between the Left and Right Carotid Arteries in the Young. Acta Neurologica Scandinavica, 115, 409-412.
http://dx.doi.org/10.1111/j.1600-0404.2007.00828.x

 
 
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