Dataset Information

Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.

ABSTRACT:

Background

Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference-Individual Participant Data Collaboration.

Methods

One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared.

Results

We analyzed 53 172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm Hg systolic BP thresholds (both P<0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all P<0.001). Higher arm BP models better predicted cardiovascular events with Framingham and atherosclerotic cardiovascular disease risk scores (both P<0.001) and reclassified 4.6% and 3.5% of participants respectively to higher risk categories compared with lower arm BPs).

Conclusions

Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension.

Registration

URL: https://www.

Clinicaltrials

gov; Unique identifier: CRD42015031227.

SUBMITTER: Clark CE

PROVIDER: S-EPMC9444257 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.

Clark Christopher E CE Warren Fiona C FC Boddy Kate K McDonagh Sinéad T J STJ Moore Sarah F SF Teresa Alzamora Maria M Ramos Blanes Rafel R Chuang Shao-Yuan SY Criqui Michael H MH Dahl Marie M Engström Gunnar G Erbel Raimund R Espeland Mark M Ferrucci Luigi L Guerchet Maëlenn M Hattersley Andrew A Lahoz Carlos C McClelland Robyn L RL McDermott Mary M MM Price Jackie J Stoffers Henri E HE Wang Ji-Guang JG Westerink Jan J White James J Cloutier Lyne L Taylor Rod S RS Shore Angela C AC McManus Richard J RJ Aboyans Victor V Campbell John L JL

Hypertension (Dallas, Tex. : 1979) 20220802 10

<h4>Background</h4>Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference-Individual Participant Data Collaboration.<h4>Methods</h4>One-stage multivariable Cox regression models, stratif ...[more]

PMID: 35916147

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Dataset Information

Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.

Background

Methods

Results

Conclusions

Registration

Clinicaltrials

Publications

Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.

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