Akira Hirono1, Kenya Kusunose2, Norihito Kageyama3, Masayuki Sumitomo4, Masahiro Abe5, Hiroyuki Fujinaga6, Masataka Sata1. 1. Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. 2. Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. Electronic address: kusunosek@tokushima-u.ac.jp. 3. Department of Cardiovascular Medicine, Tokushima Prefectural Miyoshi Hospital, Tokushima, Japan. 4. Department of Surgery, Tokushima Prefectural Miyoshi Hospital, Tokushima, Japan. 5. Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan. 6. Department of Cardiovascular Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan.
Abstract
BACKGROUND: An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. METHODS: From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. RESULTS: During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). CONCLUSIONS: IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg.
BACKGROUND: An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. METHODS: From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. RESULTS: During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01-1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). CONCLUSIONS:IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg.
Authors: Christopher E Clark; Daniel Thomas; David J Llewellyn; Luigi Ferrucci; Stefania Bandinelli; John L Campbell Journal: Br J Gen Pract Date: 2020-06-25 Impact factor: 5.386
Authors: Christopher E Clark; Fiona C Warren; Kate Boddy; Sinead T J McDonagh; Sarah F Moore; John Goddard; Nigel Reed; Malcolm Turner; Maria Teresa Alzamora; Rafel Ramos Blanes; Shao-Yuan Chuang; Michael Criqui; Marie Dahl; Gunnar Engström; Raimund Erbel; Mark Espeland; Luigi Ferrucci; Maëlenn Guerchet; Andrew Hattersley; Carlos Lahoz; Robyn L McClelland; Mary M McDermott; Jackie Price; Henri E Stoffers; Ji-Guang Wang; Jan Westerink; James White; Lyne Cloutier; Rod S Taylor; Angela C Shore; Richard J McManus; Victor Aboyans; John L Campbell Journal: Hypertension Date: 2020-12-21 Impact factor: 10.190