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ABSTRACT
Background:
Previous studies showed that great difference of inter-arm blood pressure (IABP) was associated with adverse cardiovascular outcomes. However, these studies had measurement bias because blood pressure (BP) was measured sequentially for each arm. Then, the aim of present study, using simultaneous BP measurement, is to investigate the association between ankle brachial index (ABI), brachial ankle pulse wave velocity (baPWV) and IABP difference in patients without cardiovascular disease.
Methods:
We conducted cross sectional study from medical data and selected 153 (116 men, 37 women) patients aged 18 years or older. Simultaneous BP measurements were recorded using automatic oscillometric monitor equipped with dual arm cuffs in both arms. At the same day, ABI, baPWV, and physical parameters were evaluated.
Results:
The mean age of the subjects was 52.8 ± 9.9 and the difference of inter-arm systolic BP (SBP) and diastolic BP (DBP) were 5.6 ± 4.3 and 4.5 ± 3.7 mm Hg. Compared with group with an inter-arm SBP difference less than 5 mm Hg, group with an inter-arm SBP difference more than 5 mm Hg was more older (p = 0.012), more higher proportion of patient whose left arm SBP was higher than right (p = 0.004), higher left arm SBP (p = 0.044) and higher baPWV (p = 0.025). However, the difference of IABP in SBP and DBP had no significant correlation with the age (r = 0.152, p = 0.06 and r = 0.03, p = 0.715), ABI (r = 0.021, p = 0.801 and r = 0.131, p = 0.105) and baPWV (r = 0.115, p = 0.158 and r = 0.068, p = 0.403).
References
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Table 1.
Baseline clinical characteristics of the study subjects (n = 153)
| Characteristic | Male (n = 116) | Female (n = 37) | p-value |
|---|---|---|---|
| Age (yr) | 52.5 ± 9.8 | 53.8 ± 10.5 | 0.49 |
| Hypertension | 58 (50) | 19 (51.4) | 0.886 |
| Diabetes mellitus | 24 (20.7) | 5 (13.5) | 0.332 |
| Hyperlipidemia | 80 (69) | 28 (75.7) | 0.435 |
| Current smoking | 45 (38.8) | 9 (24.3) | 0.109 |
| Alcohol intake | 68 (58.6) | 17 (45.9) | 0.177 |
| Regular exercise >150 min/wk | 55 (47.4) | 9 (24.3) | 0.013* |
| Body mass index (kg/m2) | 25.2 ± 2.7 | 24.5 ± 3.4 | 0.22 |
| Left SBP (mm Hg) | 128.7 ± 14.2 | 128.7 ± 12.5 | 0.98 |
| Left DBP (mm Hg) | 77.7 ± 12.2 | 73.9 ± 8.6 | 0.043† |
| Right SBP (mm Hg) | 126.9 ± 13.4 | 124.6 ± 9.3 | 0.35 |
| Right DBP (mm Hg) | 77.6 ± 12.2 | 73.7 ± 9.3 | 0.081 |
| Left SBP (mm Hg) > right SBP (mm Hg) | 74 (63.8) | 27 (73) | 0.462 |
| Left DBP (mm Hg)> right DBP (mmHg) | 60 (51.7) | 18 (48.6) | 0.668 |
| Mean inter-arm difference in SBP 5 (mm Hg) ≥ | 56 (48.3) | 26 (70.3) | 0.019* |
| Mean inter-arm difference in DBP 5 (mm Hg) ≥ | 50 (45.7) | 16(35.1) | 0.259 |
| Mean inter-arm difference in DBP 5 (mm Hg) ≥ | 5.0 ± 4.0 | 7.6 ± 4.6 | 0.001† |
| Mean inter-arm difference in DBP 5 (mm Hg) ≥ | 4.8 ± 4.1 | 3.9 ± 2.4 | 0.232 |
| Heart rate | 76.8 ± 12.0 | 73.7 ± 11.4 | 0.171 |
| Right baPWV (cm/sec) | 1,450.6 ± 223.1 | 1,509.5 ± 317.1 | 0.211 |
| Left baPWV (cm/sec) | 1,423.3 ± 255.2 | 1,497 ± 301.2 | 0.145 |
| Right ankle-brachial index | 1.20 ± 0.12 | 1.18 ± 0.13 | 0.528 |
| Left ankle-brachial index | 1.19 ± 0.13 | 1.16 ± 0.11 | 0.345 |
| Mean baPWV (cm/sec) | 1,436.9 ± 230.5 | 1,503.3 ± 306.4 | 0.163 |
| Mean ankle-brachial index | 1.19 ± 0.12 | 1.17 ± 0.11 | 0.38 |
Table 2.
Comparison of groups with and without in systolic blood pressure between arms 5 mm Hg or more
| Variable | Mean interarn difference in SBP < 5 (n = 71) | Mean interarn difference in SBP 5 ≥ (n = 82) | p-value |
|---|---|---|---|
| Age (yr) | 50.6 ± 9.8 | 54.6 ± 9.8 | 0.012* |
| Male | 60 (84.5) | 56 (68.3) | 0.019† |
| Hypertension | 30 (42.3) | 47 (57.3) | 0.063 |
| Diabetes mellitus | 12 (16.9) | 17 (20.7) | 0.547 |
| Hyperlipidemia | 47 (66.2) | 61 (74.4) | 0.267 |
| Current smoking | 29 (40.8) | 25 (30.5) | 0.181 |
| Alcohol intake | 42 (59.2) | 43 (52.4) | 0.404 |
| Regular exercise > 150 min/wk | 26 (36.6) | 38 (46.3) | 0.224 |
| Body mass index (kg/m2) | 25.1 ± 3.1 | 25.0 ± 2.7 | 0.804 * |
| Left SBP (mm Hg) | 126.3 ± 12.2 | 130.8 ± 14.8 | 0.044* |
| Left DBP (mm Hg) | 77.0 ± 11.2 | 76.7 ± 11.8 | 0.873 |
| Right SBP (mm Hg) | 125.5 ± 12.0 | 127.2 ± 13.8 | 0.416 |
| Right DBP (mm Hg) | 77.1 ± 11.2 | 76.3 ± 12.1 | 0.678 |
| Mean SBP (mm Hg) | 125.09 ± 12.0 | 129.0 ± 13.6 | 0.139 |
| Mean DBP (mm Hg) | 77.0 ± 10.8 | 76.5 ± 11.6 | 0.765 |
| Left SBP (mm Hg) > right SBP (mm Hg) | 44 (62) | 57 (69.5) | 0.004† |
| Left DBP (mm Hg) > right DBP (mm Hg) | 39 (54.9) | 39 (47.6) | 0.560 |
| Mean inter-arm difference in DBP (mm Hg) | 4.2 ± 4.2 | 4.8 ± 3.3 | 0.337 |
| Heart rate | 76 ± 11.1 | 76 ± 12.7 | 0.965 |
| Right baPWV (cm/sec) | 1,414.4 ± 194.1 | 1,508.5 ± 282.6 | 0.019* |
| Left baPWV (cm/sec) | 1,394.2 ± 193.7 | 1,481.7 ± 314.0 | 0.043* |
| Right ankle-brachial index | 1.2 ± 0.1 | 1.2 ± 0.1 | 0.954 |
| Left ankle-brachial index | 1.17 ± 0.1 | 1.19 ± 0.1 | 0.494 |
| Mean baPWV (cm/sec) | 1,404.3 ± 189.5 | 1,495.1 ± 289.4 | 0.025* |
| Mean ankle-brachial index | 1.18 ± 0.1 | 1.19 ± 0.1 | 0.72 |
Table 3.
Comparison of groups with and without in DBP between arms 5 mm Hg or more
| Variable | Mean inter-arm difference in DBP < 5 (n = 87) | Mean inter-arm difference in DBP 5 (n = 66) | p-value |
|---|---|---|---|
| Age (yr) | 53.0 ± 9.7 | 52.5 ± 10.4 | 0.728 |
| Male | 63 (72.4) | 53 (80.3) | 0.259 |
| Hypertension | 41 (47.1) | 36 (54.5) | 0.363 |
| Diabetes mellitus | 15 (17.2) | 14 (21.2) | 0.535 |
| Hyperlipidemia | 57 (65.5) | 51 (77.3) | 0.114 |
| Current smoking | 30 (34.5) | 24 (36.4) | 0.809 |
| Alcohol intake | 45 (51.7) | 40 (36.7) | 0.274 |
| Regular exercise > 150 min/wk | 39 (44.8) | 25 (37.9) | 0.388 |
| Body mass index (kg/m2) | 25.0 ± 2.9 | 25.0 ± 2.8 | 0.992 |
| Left SBP (mm Hg) | 127.9 ± 12.2 | 130.0 ± 15.8 | 0.400 |
| Left DBP (mm Hg) | 75.9 ± 10.5 | 78.0 ± 13.3 | 0.249 |
| Right SBP (mm Hg) | 126.3 ± 12.4 | 126.6 ± 13.8 | 0.885 |
| Right DBP (mm Hg) | 75.7 ± 10.2 | 78.0 ± 13.3 | 0.252 |
| Mean SBP (mm Hg) | 127.1 ± 12.0 | 128.2 ± 14.3 | 0.603 |
| Mean DBP (mm Hg) | 75.8 ± 10.3 | 78.0 ± 12.3 | 0.225 |
| Left SBP (mm Hg) > right SBP (mm Hg) | 56 (64.4) | 45 (68.2) | 0.793 |
| Left DBP (mm Hg) > right DBP (mm Hg) | 40 (46) | 38 (57.6) | 0.003* |
| Mean inter-arm difference in DBP (mm Hg) | 4 .6 ± 3.6 | 6.9 ± 4.8 | 0.002† |
| Heart rate | 75.5 ± 11.5 | 76.8 ± 12.5 | 0.513 |
| Right baPWV (cm/sec) | 1,461.5 ± 204.1 | 1,469.2 ± 300.2 | 0.851 |
| Left baPWV (cm/sec) | ,445.7 ± 202.1 | 1,435.0 ± 337.2 | 0.808 |
| Right ankle-brachial index | 1.2 ± 0.1 | 1.18 ± 0.1 | 0.516 |
| Left ankle-brachial index | 1.18 ± 0.1 | 1.19 ± 0.1 | 0.606 |
| Mean baPWV (cm/sec) | 1453.6 ± 200.1 | 1,452.1 ± 308.1 | 0.971 |
| Mean ankle-brachial index | 1.19 ± 0.1 | 1.19 ± 0.1 | 0.958 |
Table 4.
Correlation between mean inter-arm difference in BP and ABI, baPWV, and other variables
| Variable | Mean inter-arm difference in SBP (mm Hg) | Mean inter-arm difference in DBP (mm Hg) | ||
|---|---|---|---|---|
| Correlation coefficient (r) | p-value | Correlation coefficient (r) | p-value* | |
| Age | 0.152 | 0.060 | 0.030 | 0.715 |
| Mean SBP | 0.113 | 0.165 | 0.023 | 0.780 |
| Mean DBP | 0.019 | 0.813 | 0.086 | 0.291 |
| Mean ABI | 0.021 | 0.801 | 0.131 | 0.105 |
| Mean baPWV | 0.115 | 0.158 | 0.068 | 0.403 |
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