Abstract 17204: Association Between Interarm Systolic Blood Pressure Differential and Peripheral Artery Disease: A Population Database of Over 3.6 Million Subjects
Introduction: Assessment of blood pressure (BP) in both arms is part of clinical care and recommended by guidelines. Recent small studies suggest that an interarm blood pressure differential (IBPD) >10mmHg is associated with all-cause mortality, yet uncertainty remains around different IBPD thresholds and association with other vascular phenotypes. We sought to investigate the prevalence, different cut-offs, and association of IBPD with peripheral artery disease (PAD).
Methods: We analyzed data on 3.6 million participants who underwent PAD screening in the Life Line Screening Program from 2003-2008. All subjects completed a medical and lifestyle questionnaire and were evaluated with bilateral ankle brachial indices (ABI). PAD was considered present with an ABI < 0.9. Association between IBPD and PAD was identified using multivariate logistic regression analysis.
Results: Among 3,666,938 subjects, 455,227 ( 14.1%) had an IBPD > 10 mmHg, including 313,350 (9.7%) 11-15 mmHg, 124,870 (3.9%) 16-20 mmHg, and 17,007 (0.5%) > 20 mmHg. An IBPD >10mmHg was more common among older individuals (10.7%, 12.6%, 14.8%, and 17.4% in age > 40, 41-60, 61-80 and 80, respectively), males (14.8% vs. 13.7% in females, P<0.001), and differed by race/ethnicity (whites 14.1%, blacks 14.1%, Hispanics 13.6%, Native American 15.6%, and other 15.2%, p<0.001). The prevalence of PAD increased in a graded fashion with progressively larger IBPDs (P<0.0001). After adjustment for age, sex, race, smoking, diabetes, hypertension, hypercholesterolemia, physical activity, and family history of cardiovascular disease, IBPD > 10 mm Hg was a powerful predictor for PAD (OR 1.68 [1.66 - 1.70]). Compared with an IBPD≤10mmHg, 11-15 (OR 1.34 [1.32 - 1.36]), 16-20 (OR 1.82 [1.79 - 1.86]), and >20 (OR 9.03 [8.70 - 9.38]) was significantly associated with PAD.
Conclusions: Abnormal IBPDs are commonly detected during bilateral BP assessments and may identify subjects at significantly increased odds of PAD. Whether such patients may benefit from early-targeted screening for PAD merits further investigation.
- © 2013 by American Heart Association, Inc.