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Higher arm versus lower arm systolic blood pressure and cardiovascular outcomes: a meta-analysis of individual participant data from the INTERPRESS-IPD Collaboration

Clark, Christipher E, Warren, Fiona C, Boddy, Kate, McDonagh, Sinead TJ, Moore, Sarah F, Alzamora, Maria Teresa, Blanes, Rafel Ramos, Chuang, Shao-Yuan, Criqui, Michael H, Dahl, Marie, Engstom, Gunnar, Erbel, Raimund, Espeland, Mark, Ferrucci, Luigi, Guerchet, Maelenn, Hattersley, Andrew, Lahoz, Carlos, McClelland, Robyn L, McDermott, Mary M, Price, Jackie, Stoffers, Henri E, Wang, Ji-Guang, Westerink, Jan, White, James ORCID:, Cloutier, Lyne, Taylor, Rod S, Shore, Angela C, McManus, Ricahrd J, Aboyans, Victor and Campbell, John L 2022. Higher arm versus lower arm systolic blood pressure and cardiovascular outcomes: a meta-analysis of individual participant data from the INTERPRESS-IPD Collaboration. Hypertension 79 , pp. 2328-2335. 10.1161/HYPERTENSIONAHA.121.18921

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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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Additional Information: This is an open access article under the terms of the Creative Commons Attribution License
Publisher: American Heart Association
ISSN: 0194-911X
Date of First Compliant Deposit: 8 June 2022
Date of Acceptance: 7 June 2022
Last Modified: 20 May 2023 21:15

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