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Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration

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  • Christopher E Clark
  • Fiona C Warren
  • Kate Boddy
  • Sinead T J McDonagh
  • Sarah F Moore
  • John Goddard
  • Nigel Reed
  • Malcolm Turner
  • Maria Teresa Alzamora
  • Rafel Ramos Blanes
  • Shao-Yuan Chuang
  • Michael Criqui
  • Marie Dahl
  • Gunnar Engström
  • Raimund Erbel
  • Mark Espeland
  • Luigi Ferrucci
  • Maëlenn Guerchet
  • Andrew Hattersley
  • Carlos Lahoz
  • Robyn L McClelland
  • Mary M McDermott
  • Henri E Stoffers
  • Ji-Guang Wang
  • Jan Westerink
  • James White
  • Lyne Cloutier
  • Rod S Taylor
  • Angela C Shore
  • Richard J McManus
  • Victor Aboyans

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Original languageEnglish
Pages (from-to)HYPERTENSIONAHA12015997
Issue number2
Early online date21 Dec 2020
Publication statusPublished - 7 Feb 2021


Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.

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