Association Between Inter-arm Blood Pressure Difference And Peripheral Vascular Disease In Chinese Hypertensive Population

Objective:To investigate the prevalence of inter-arm blood pressure differences(IAD)in patients with hypertension and the relationship between inter-arm blood pressure differences and peripheral vascular diseases(PAD).Methods:All patients were enrolled in the China Stroke Primary Prevention Trial(CSPPT)in hypertensive patients aged 45-75 years.Patients with hypertension were defined as systolic blood pressure(SBP)≥140 mm Hg or diastolic blood pressure(DBP)≥90mm Hg in sitting position or taking antihypertensive medication.An arteriosclerosis analyzer(VP-100BP203RPEⅡmodel,PWV/ABI model)manufactured by Colin Company in Japan and approved by the Food and Drug Administration(FDA)was used to measure the high values of ankle brachial index(ABI)divided by the upper arm systolic pressure.PAD is defined as ABI<0.9.Abnormal IAD was defined as inter-arm blood systolic pressure differences(s IAD)or inter-arm blood diastolic pressure differences(d IAD)≥10 mm Hg.Multivariate Logistic regression analysis was used to study the correlation between interarm blood pressure difference and peripheral vascular diseases.Results:A total of 15,284 patients with hypertension were included in the study,including 5970 males(40.36%)and 9314 females(60.94%),with an average age of64.5±7.4 years.In this study,the average s IAD was 7.56±7.84mm Hg,and the average s IAD was 3.71±4.10mm Hg.27.4%of patients had s IAD≥10mm Hg,8.2%had d IAD≥10mm Hg.The risk of PAD increases with the increase of s IAD or d IAD.Patients with s IAD≥10mm Hg had an increased risk for PAD compared with those with s IAD<10mm Hg(OR:8.29,95%CI 6.73-10.22;P<0.01).After multivariable adjustment,the hazard ratio was(OR:7.62,95%CI 6.03-9.62;P<0.01).Compared with those with d IAD<10mm Hg,the hazard ratio for PAD risk in those with d IAD≥10mm Hg was(OR:4.70,95%CI 3.81-5.80;P<0.01).After multivariable adjustment,the hazard ratio was(OR:4.10,95%CI 3.23-5.21;P<0.01).Both s IAD and d IAD were associated with PAD,and were more significant in the population with BMI<24kg/m~2,P-interaction<0.05.Conclusion:Inter-arm blood pressure difference is significantly associated with peripheral vascular disease in hypertensive patients.IAD could provide a simple screening test in routine practice to identify those most likely to have PAD and benefit from early aggressive prevention in further evaluation.