Abstract P075: Inter-arm Blood Pressure Difference and Cardiovascular Disease Risk in the Framingham Heart Study
Background: An elevated inter-arm blood pressure difference (IABPD) is common and easily determined in the office. The relationship between IABPD and cardiovascular disease (CVD) risk is uncertain.
Objectives: To describe the prevalence of IABPD in the Framingham Heart Study (FHS) original and offspring cohorts and to determine the association between IABPD and incident CVD.
Methods: We examined 3,390 (56.3% female) participants aged 40 years and older, free of CVD at baseline, with a mean age of 61.1±11.3 years who attended a FHS examination between 1991 and 1994 (original cohort) and from 1995 to 1998 (offspring cohort). Elevated absolute IABPD was defined as >10mmHg using the average of initial and repeat Doppler derived blood pressure measurements obtained in both the right and left arms in the supine position after a minimum of 5 minutes of rest. Participants were followed through 2010 for incident CVD events. Age- and sex-adjusted, and multivariable Cox proportional hazards regression analyses were performed to investigate the effect of IABPD on incident CVD. Covariates in the model included current smoking, diabetes, hypertension, total cholesterol, and cholesterol lowering treatment.
Results: Mean IABPD was 4.4 (range 0 to 78). Elevated IABPD was present in 317 (9.4%) participants. The median follow-up time was 11.8 years, during which 598 subjects (17.6%) experienced a first CVD event including 83 (26.2%) of participants with elevated IABPD. Participants with elevated IABPD were older (60.9 years vs. 62.95 years, P=0.002) and had a greater prevalence of diabetes (13.3% vs. 7.5%, P=0.0011), higher systolic (136.3 mmHg vs. 129.3 mmHg, P<0.0001) blood pressure, greater anti-hypertension medication use (43.6% vs. 25.7%, P<0.0001) and a higher total cholesterol level (212.1 mg/dL vs. 206.5 mg/dL, P=0.0242). There was no difference in current smoking (13.9% vs. 12.3%, P=0.721). Elevated IABPD was associated with a significantly increased hazard of incident CVD events in both the age- and sex-adjusted (hazard ratio 1.47, 95% CI 1.16, 1.85; P=0.0012) and multivariable adjusted models (hazard ratio 1.40, 95% CI, 1.11 to 1.78; P=0.0047). For each 1 mmHg increase in absolute IABPD, the hazard ratio for incident CVD events was 1.016 (CI, 1.002 to 1.031; P=0.021) in the fully-adjusted model.
Conclusions: In this community-based cohort, an elevated IABP is common and is associated with a significant increase in risk for CVD events.
- © 2013 by American Heart Association, Inc.