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

Clark, C. E. et al. (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(10), pp. 2328-2335. (doi: 10.1161/HYPERTENSIONAHA.121.18921) (PMID:35916147) (PMCID:PMC9444257)

Abstract

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. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: CRD42015031227.

• Item Type: Articles
• Additional Information: The INTERPRESS-IPD Collaboration was funded by the National institute for Health Research (NIHR) Research for Patient Benefit Programme (PBPG-0215-36009). C.E. Clark is funded by NIHR School for Primary Care Research (SPCR) Grant (Ref: 512). S.T.J. McDonagh is funded by NIHR SPCR Fellowship. R.J. McManus is supported by NIHR Oxford CLAHRC. A.C. Shore is supported by NIHR Exeter Clinical Research Facility. J.-G. Wang supported by grants from National Natural Science Foundation of China (91639203 and 82070435), Beijing and Shanghai Commission of Science and Technology (19DZ2340200), Shanghai, China.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Clark, C. E., Warren, F. C., Boddy, K., McDonagh, S. T.J., Moore, S. F., Teresa Alzamora, M., Ramos Blanes, R., Chuang, S.-Y., Criqui, M. H., Dahl, M., Engström, G., Erbel, R., Espeland, M., Ferrucci, L., Guerchet, M., Hattersley, A., Lahoz, C., McClelland, R. L., McDermott, M. M., Price, J., Stoffers, H. E., Wang, J.-G., Westerink, J., White, J., Cloutier, L., Taylor, R. S., Shore, A. C., McManus, R. J., Aboyans, V., and Campbell, J. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Hypertension
• Publisher: American Heart Association
• ISSN: 0194-911X
• ISSN (Online): 1524-4563
• Published Online: 02 August 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Hypertension 79(10):2328-2335
• Publisher Policy: Reproduced under a Creative Commons License

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