Simultaneously measured interarm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients

Background/Introduction Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events, previous studies have demonstrated associations with other risk parameters. Purpose We aimed to reproduce these associations in a cohort of 199 treated, at-risk, hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage. Methods Simultaneously measured Inter-arm blood pressure differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients of a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multivariate regression models. Results Out of 199 participants, 90 showed an Inter-arm blood pressure difference of more than 5 mmHg. The Inter-arm difference was not associated with PWV. Furthermore, neither observed single blood pressure measurements nor 24 hour ambulatory blood pressure was associated with Inter-arm blood pressure differences. Conclusion In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design or the sample characteristics of this treated, hypertensive cohort may explain the negative results. The limited sample size of the study poses a challenge to the detection of smaller effects in our study. FUNDunding Acknowledgement Type of funding sources: None.

Abstract P159: Moderate To Severe Obstructive Sleep Apnea Is Independently Associated With Inter-arm Systolic Blood Pressure Difference: Tokyo Sleep Heart Study

Objective: Obstructive sleep apnea (OSA) is recognized as an independent risk factor for cardiovascular disease. On the other hand, inter-arm systolic blood pressure difference (IAD), inter-ankle systolic blood pressure difference (IAND), and ankle-brachial index (ABI) are all known predictors of cardiovascular events. The aim of the present study was to investigate the association between OSA and four-limb blood pressure differences. Methods: We conducted this cross-sectional study in a large sleep cohort from Tokyo Sleep Heart Study. In 2643 consecutive patients who visited our sleep clinic for polysomnography between 2005 and 2017; all the subjects underwent blood pressure measurement simultaneously in all the four limbs by oscillometric methods. Results: The prevalence rate of IAD ≥ 10 mm Hg was significantly higher in the severe OSA (apnea-hypopnea index ≥ 30) group (4.6%) than in the no/mild (apnea-hypopnea index < 15) OSA group (1.6%). Multivariate logistic regression analysis also identified moderate to severe OSA as being significantly associated with IAD ≥ 10 mm Hg, even after adjustments for confounding variables [moderate OSA; odds ratio (OR): 3.627, 95% confidence interval (CI): 1.056-12.465, P = 0.041. Severe OSA; OR: 3.778, 95% CI: 1.113-12.595, P = 0.031]. However, there were no significant associations of the OSA severity with IAND ≥ 15 mm Hg or ABI < 0.9. Conclusions: Moderate to severe OSA was independently associated with the IAD, not but with the IAND or ABI. The plausible explanation is that the negative intrathoracic pressure caused by OSA may exert an adverse impact on the structural properties of the thoracic aorta. Our findings emphasized that physicians should be careful of IAD, easily applied clinical tool, to evaluate subclinical cardiovascular damage and cardiovascular risk in patients with OSA.

Elevated Interarm Systolic Blood Pressure Difference Is Positively Associated with Increased Likelihood of Coronary Artery Disease

Background. Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We investigated the relationship between interarm systolic blood pressure difference and coronary artery disease. Methods. We retrospectively analyzed data for patients undergoing coronary angiography and brachial-ankle pulse wave velocity examination during hospitalization from 2013 to 2018. Patients underwent simultaneous upper arm blood pressure measurement. Interarm systolic blood pressure difference (IASBPD) was defined as the absolute value of the difference between the right and left upper limb systolic blood pressure. Patients with IASBPD ≥10 mmHg constituted the high group, and those with IASBPD <10 mmHg constituted the normal group. We also recorded data for cardiovascular risk factors. Coronary artery disease was defined as ≥50% vessel stenosis or having undergone interventional therapy according to coronary angiography results. Results. Compared with the normal group, the number of patients with coronary artery disease was higher in the high group (86.1% vs. 74.6%, P = 0.029 ). Multiple logistic regression showed that IASBPD ≥10 mmHg were positively correlated with coronary artery disease (odds ratio, 2.313; 95% confidence interval, 1.086–4.509; P = 0.029 ), and as the IASBPD value increased, the correlation also gradually increased. Conclusions. IASBPD ≥10 mmHg was positively related to coronary artery disease and increased IASBPD values were correlated with coronary artery disease severity.

Non-dipping nocturnal blood pressure correlates with obstructive sleep apnoea severity in normotensive subjects and may reverse with therapy

Obstructive sleep apnoea (OSA) is highly prevalent in the general population with an estimated global prevalence of close to one billion affected [1]. Hypertension is present in up to 50% of patients with OSA, which is about double the prevalence of hypertension in general population studies [2]. A non-dipping nocturnal BP profile (<10% day-to-night systolic blood pressure difference) is especially likely in OSA patients [3–6], even in the absence of significant hypertension. The likelihood of non-dipping BP correlates with OSA severity in population studies [7] and cardiovascular events are more frequent in OSA patients with a non-dipping BP profile than those with a normal dipping pattern, even in the absence of diagnosed hypertension [8]. Despite the extensive publications on the relationships between OSA and hypertension and responses to therapy, there are few data on the relationship between OSA and 24-hour BP patterns in OSA patients who are normotensive on 24-hour ambulatory BP monitoring (ABPM) and free of any cardiovascular disease or other chronic disorders.

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography

Aim. Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods. The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results. There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion. The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.