Abstract 16990: An Interarm Difference in Brachial Pressure Greater than 10 mmHg Highly Significantly Predicts Peripheral Arterial Disease Independently of Clinic and Self-Measured Home Blood Pressures: Japan Morning Surge-Home Blood Pressure (J-HOP) Vascular Study

Abstract

Background: A greater interarm difference in brachial systolic pressure (IAD-SBP) and peripheral arterial disease (PAD) is associated with risk for cardiovascular events and mortality. However, it remains unclear whether or not IAD-SBP predicts PAD independently of cardiovascular risk factors, including clinic and self-measured home BPs.

Objective: The aim of this study was to investigate the association between the IAD-SBP and PAD and to identify the threshold of IAD-SBP for predicting PAD in high-risk patients.

Methods: The study subjects of the J-HOP Vascular Study were 2396 participants of the J-HOP Study with one or more cardiovascular risk factors (n=4019). The BP was measured simultaneously in both arms and ankles using an automated device (Omlon-Colin Inc., Japan), and the interarm BP difference was calculated as the absolute difference between the right and left brachial systolic BP.

Results: The prevalence of PAD (ABI<0.9) and borderline ABI (0.9≤ABI<0.10) were 3.2% and 7.5%, respectively. The patients with an interarm difference in brachial pressure of more than 10 mmHg made up 9% of the total participants (n=215). The 10 mmHg of interarm difference demonstrated a sensitivity of 71.8% and a specificity of 94.7% in diagnosing PAD. The prevalences of PAD and borderline ABI were 12.6% and 17.2% in 215 patients with IAD-BSP ≥10 mmHg than 2.3% and 6.5% in 2181 patients with IAD-BSP <10 mmHg (both p<0.0001). After controlling for age, body mass index, and cardiometabolic risk factors, and clinic and self-measured home BPs, the odds ratio of PAD and borderline ABI by IAD-BSP ≥10 mmHg was 8.16 [95%CI: 4.65-14.33, P<0.001] and 3.21 [95%CI: 2.10-4.93, P<0.001] when compared to IAD-BSP <10 mmHg.

Conclusion: The interarm difference in brachial systolic pressure is a simple and valuable predictor of PAD independently of clinic and self-measured home BP in a population with cardiovascular risk factors. The most precise predictive threshold of interarm difference was 10 mmHg, which predicted PAD with an odds ratio of 8.