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Objective

A difference in systolic blood pressure between arms is associated with vascular disease and mortality 1. Background. Differences in systolic blood pressure (SBP) of 10-15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis.

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Objective

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  1. A difference in systolic blood pressure between arms is associated with vascular disease and mortality1 Background Differences in systolic blood pressure (SBP) of 10-15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. Objective To establish whether a difference in SBP between arms is associated with peripheral or cardiovascular (CV) disease, and with an increased risk of CV or all-cause mortality. Methods • Bibliographic database search (Medline, Embase, Cochrane, and Medline databases) for studies published before July 2011, showing differences in SBP between arms and outcomes data. • A random-effects meta-analysis. 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012 Jan 27, Epub ahead of print . 2012 DOI:10.1016/S0140-6736(11)61710.

  2. Main findings of the systematic review and meta-analysis1 20 trials met inclusion criteria. Pooledresults of five invasive studies using angiography • The mean difference in SBP between arms was 37 mm Hg (95% CI, 35.4–38.4) for proven subclavian stenosis (>50% occlusion). • A difference of 10 mm Hg or more was strongly associated with subclavianstenosis (risk ratio [RR], 8.8; 95% CI, 3.6–21.2). Pooledresults of non- invasive studies • A difference of 15 mm Hg or more was associated with peripheral vascular disease, pre-existing cerebrovascular disease, and increased cardio vascular mortality (hazard ratio [HR], 1.7; 95% CI, 1.1–2.5) and all-cause mortality (HR, 1.6, CI, 1.1–2.3). • A difference of 10 mm Hg or higher was associated with peripheral vascular disease (five studies; RR, 2.4, CI, 1.5–3.9). 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012 Jan 27, Epub ahead of print . 2012 DOI:10.1016/S0140-6736(11)61710.

  3. A between-arms difference in systolic blood pressure of 15 mm Hg is associated with increased mortality1 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012 Jan 27, Epub ahead of print . 2012 DOI:10.1016/S0140-6736(11)61710.

  4. A between-arms difference in systolic blood pressure of 15 mm Hg is associated with increased cardiovascular mortality1 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012 Jan 27, Epub ahead of print . 2012 DOI:10.1016/S0140-6736(11)61710.

  5. AUTHORS’ CONCLUSIONS1 • A difference in SBP of 10 mm Hg or more or 15 mm Hg or more between arms could identify patients at high risk of asymptomatic peripheral vascular disease and mortality. • Findings from our study should be incorporated into future guidelines for hypertension and blood-pressure measurement to justify bilateral brachial measurement in the assessment of individuals, and to promote targeted screening for peripheral vascular disease and aggressive risk factor management in subject with a systolic between-arm difference. 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012 Jan 27, Epub ahead of print . 2012 DOI:10.1016/S0140-6736(11)61710.

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