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Nolde JM, Lugo-Gavidia LM, Kannenkeril D, Chan J, Robinson S, Jose A, Joyson A, Schlaich L, Carnagarin R, Azzam O, Kiuchi MG, Schlaich MP. Simultaneously measured inter-arm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients. J Hum Hypertens 2022; 36:811-818. [PMID: 34354250 DOI: 10.1038/s41371-021-00588-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022]
Abstract
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. 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. Simultaneously measured inter-arm blood pressure (BP) differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients from a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multi-variate regression models. Out of 199 participants, 90 showed an inter-arm BP difference of more than 5 mmHg. The inter-arm difference was not associated with PWV. Furthermore, neither observed single BP measurements nor 24 hour ambulatory BP was associated with inter-arm BP differences. In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design and the sample characteristics of this treated, hypertensive cohort may have contributed to the negative findings. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.
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Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Dennis Kannenkeril
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Justine Chan
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sandi Robinson
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Ancy Jose
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Anu Joyson
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Luca Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Omar Azzam
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia. .,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia. .,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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2
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Essa RA, Ahmed SK. Prevalence of inter-arm blood pressure difference among young healthy adults: Results from a large cross-sectional study on 3235 participants. Ann Med Surg (Lond) 2022; 77:103631. [PMID: 35638020 PMCID: PMC9142544 DOI: 10.1016/j.amsu.2022.103631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
More than 100 years ago, the difference in blood pressure (BP) between arms was first reported. Recent studies have shown that different blood pressure between the right and left arm leads to cardiovascular events. Three thousand and thirty volunteers participated in our cross-sectional study. The sIABP was equal in 163 of 3030 persons (5.37%), dIABP was equal in 222 out of 3030 persons (7.32%), from a total of 792/3030 persons (26.1%) sIAD >10 mmHg, and dIAD > or = 10 mmHg was found in 927 out of 3030 persons (33.5%) in the right arm, and 32.4% in the left arm. In 2692 of 3030 volunteers BP, initially recorded in the dominant hand (right arm), showing sIAD > or = 10 mmHg was found in 943 (37.1%) volunteers, and when the first measurement was done in 338 left-handed volunteers it showed sIAD > or = 10 mmHg in 112 of 338 (34.1%), P < .001; 95% confidence interval for systolic right hand were (115.73: 116.73), and for systolic left hand 95% confidence interval were (113.17:114.15). Furthermore, height, residential area, and heart rate above 90 bpm had a significant effect on IAD (P = . 041, 0.002, <001, respectively). In conclusion, significant inter-arm systolic and diastolic BP differences above (10 mm Hg) is common in the young, healthy population. Hand dominance is a significant consideration while measuring blood pressure. It is mandatory to measure blood pressure in both arms in a sitting position with a stable condition. Blood pressure should be measured in both arms due to differences in values between them to avoid under-diagnosis of hypertension. Accurate measurement of blood pressure is mandatory to prevent cardiovascular, cerebrovascular, and renal diseases. In this study, the prevalence of IAD among young, healthy adults was reported. Hand dominance is a significant consideration while measuring blood pressure.
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3
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He J, Ou J, He A, Shu L, Liu T, Qu R, Xu X, Chen Z, Yan Y. A new approach for daily life Blood-Pressure estimation using smart watch. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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4
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Sasamoto N, Akutsu K, Yamamoto T, Otsuka T, Sangen H, Hayashi H, Murata H, Miyachi H, Hosokawa Y, Tara S, Tokita Y, Miyata S, Morota T, Nitta T, Shimizu W. Characteristics of the Inter-arm Difference in Blood Pressure in Acute Aortic Dissection. J NIPPON MED SCH 2021; 88:467-474. [PMID: 33692296 DOI: 10.1272/jnms.jnms.2021_88-605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND An inter-arm difference in blood pressure (IADBP) is characteristic of acute aortic dissection (AAD), but which arm shows lower blood pressure (BP) and the mechanism of IADBP has not been fully elucidatedMethods: We identified consecutive patients with chest and/or back pain and suspected acute cardiovascular disease whose BP had been measured in both arms. We retrospectively compared the characteristics of such patients with AAD (n=93) to those without (non-AAD group, n=122). Additionally, we separately compared patients with type A AAD (TAAD group, n=58) or type B AAD (TBAD group, n=35) to non-AAD group. Characteristics included in these comparisons were patients' backgrounds and IADBP-related factors such as systolic BP (SBP) in the right arm (R) and left arm (L), R-L or L-R as the IADBP. Computed tomography (CT) findings of AD extending to the brachiocephalic artery (BCA) and/or left subclavian artery (LSCA) were examined in patients having IADBP. RESULTS In the TAAD group, the prevalence of R<130mmHg (38%-vs.-19%, p=0.009), L-R>15mmHg (19%-vs.-8%, p=0.047), L-R>20mmHg (14%-vs.-4%, p=0.029) was higher than in the non-AAD group. Multivariate analysis showed L-R>15mmHg with R<130mmHg was independently associated with TAAD (OR 25.97, 95% CI 2.45-275.67, p=0.007). However, IADBP-related factors were not associated with TBAD. AAD patients with L-R>20mmHg were all TAAD, and all aortic dissection extended to BCA just before the right common carotid artery on CT. CONCLUSIONS IADBP was characterized by R<L with low R in TAAD, but was not associated with TBAD.
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Affiliation(s)
- Nozomi Sasamoto
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Koichi Akutsu
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School.,Center for Clinical Research, Nippon Medical School Hospital
| | - Hideto Sangen
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Hideki Miyachi
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yusuke Hosokawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Shuhei Tara
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | | | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School.,Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
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Essa R, Ahmed SK, Abdul-Sahib SH, Qadir RM, Miire ZK. The Future Alert of Inter-Arm Blood Pressure Difference Among Young Healthy Population: A Cross-Sectional Study. (Preprint). J Med Internet Res 2020. [DOI: 10.2196/24195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Inter-arm Systolic Blood Pressure Difference in Physically Active, Adult Subjects. High Blood Press Cardiovasc Prev 2018; 25:303-307. [DOI: 10.1007/s40292-018-0269-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022] Open
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7
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Mayrovitz HN. Inter-arm systolic blood pressure dependence on hand dominance. Clin Physiol Funct Imaging 2018; 39:35-41. [PMID: 29938907 DOI: 10.1111/cpf.12536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/06/2018] [Indexed: 12/23/2022]
Abstract
Inter-arm systolic blood pressure differences (SBP-DIFF) ≥ 10 mmHg have been reported useful to predict future cardiovascular-related morbidities. Although well studied in patients, there is little information on healthy young adults and the role of hand-dominance as a factor affecting SBP-DIFF. As dominant arms (DOM) tend to have greater girth and muscle development than nondominant arms (NDOM) it was reasoned that cuff pressures needed to obtain SBP may be greater on DOM causing DOM SBP to be greater. To test this hypothesis and also provide typical values, SBP was measured in left and right-handers (29·4 ± 10·4 years) in whom handedness was clearly defined. Handedness was determined by a multi-question form in 90 young adults (45 male) and SBP-DIFF determined via simultaneous measurements done in triplicate on seated subjects. The percentage of left-handers in male and female sub-groups were equal at 37·8%. Results show that the absolute SBP-DIFF in left-handers (mean ± SD) was 4·4 ± 3·8 mmHg and for right-handers was 5·0 ± 4·2 mmHg (P = 0·362). There was also no statistically significant difference among 1st, 2nd and 3rd measured SBP-DIFF for either right or left-handers or differences between right and left-handers. Results show no evidence of a higher SBP in DOM and thus clarifies the hand-dominance issue as a factor not generally needing to be considered in clinical assessments. A potentially useful secondary outcome was the finding that 14·8% of this group had at least one measured SBP-DIFF ≥ 10 mmHg a fact that may have future relevance.
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Affiliation(s)
- Harvey N Mayrovitz
- College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
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8
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Schwartz CL, Clark C, Koshiaris C, Gill PS, Greenfield SM, Haque SM, Heer G, Johal A, Kaur R, Mant J, Martin U, Mohammed MA, Wood S, McManus RJ. Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study. Am J Hypertens 2017; 30:884-891. [PMID: 28475667 PMCID: PMC5861584 DOI: 10.1093/ajh/hpx073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 04/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interarm differences (IADs) ≥10 mm Hg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic IADs (ssIADs) are not well understood. METHODS Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using 2 BPTru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory BP monitoring (ABPM). WCE was defined as systolic clinic BP ≥10 mm Hg higher than daytime ABPM. RESULTS No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%), and 2nd–6th (78, 11%) (1st vs. 2nd/3rd and 2nd–6th, P < 0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (odds ratio [OR] 1.73 (95% confidence interval 1.04–2.86); 2nd/3rd, (OR 3.05 (1.68–5.53); and 2nd–6th measurements, (OR 2.58 (1.22–5.44). Nonhypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 to −8.25) only. CONCLUSIONS ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs.
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Affiliation(s)
- Claire Lorraine Schwartz
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Christopher Clark
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke’s Campus, Exeter, UK
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Paramjit S Gill
- WMS—Social Science and Systems in Health, University of Warwick, Coventry, Birmingham, UK
| | - Shelia M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sayeed M Haque
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Gurdip Heer
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Amanpreet Johal
- NIHR Clinical Research Network: West Midlands, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ramandeep Kaur
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort’s Causeway, Cambridge, Cambridgeshire, UK
| | - Una Martin
- Institute of Clinical Science, University of Birmingham, Edgbaston, Birmingham, UK
| | | | - Sally Wood
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Gaynor E, Brewer L, Mellon L, Hall P, Horgan F, Shelley E, Dolan E, Hickey A, Bennett K, Williams DJ. Interarm blood pressure difference in a post-stroke population. ACTA ACUST UNITED AC 2017; 11:565-572.e5. [DOI: 10.1016/j.jash.2017.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/02/2017] [Accepted: 06/20/2017] [Indexed: 02/01/2023]
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10
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Clark CE. The interarm blood pressure difference: Do we know enough yet? J Clin Hypertens (Greenwich) 2017; 19:462-465. [PMID: 28296043 DOI: 10.1111/jch.12982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, UK
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Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis. Br J Gen Pract 2016; 66:e838-e847. [PMID: 27789511 DOI: 10.3399/bjgp16x687553] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/18/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Various prevalence figures have been reported for inter-arm differences in blood pressure (IAD); variation may be explained by differing population vascular risk and by measurement method. AIM To review the literature to derive robust estimates of IAD prevalence relevant to community populations. DESIGN AND SETTING Systematic review and meta-analysis. METHOD MEDLINE, Embase, and CINAHL were searched for cross-sectional studies likely to represent general or primary care populations, reporting prevalence of IAD and employing a simultaneous method of measurement. Using study-level data, pooled estimates of mean prevalence of systolic IADs were calculated and compared using a random effects model. RESULTS Eighty IAD studies were identified. Sixteen met inclusion criteria: pooled estimates of prevalence for systolic IAD ≥10 mmHg were 11.2% (95% confidence interval [CI] = 9.1 to 13.6) in hypertension, 7.4% (95% CI = 5.8 to 9.2) in diabetes, and 3.6% (95% CI = 2.3 to 5.0) for a general adult population (P<0.001 for subgroup differences). Differences persisted for higher cut-off values. Prevalences were lower for East Asian than for Western populations and were overestimated by sequential measurement where this could be compared with simultaneous measurement within studies (relative risk for IAD: 2.9 [95% CI = 2.1 to 4.1]). Studies with higher mean absolute systolic pressures had higher prevalences for a systolic IAD ≥10 mmHg (P = 0.04). CONCLUSION Prevalences of IADs rise in relation to underlying cardiovascular comorbidities of the population studied, and are overestimated threefold when sequential measurement is used. Population-specific variation in prevalences of IAD should be taken into account in delivering clinical care and in planning future studies.
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Yoon H, Choi SW, Park J, Ryu SY, Han MA, Kim GS, Kim SG, Oh HJ, Choi CW. The Relationship Between the Metabolic Syndrome and Systolic Inter-Arm Systolic Blood Pressure Difference in Korean Adults. Metab Syndr Relat Disord 2015; 13:329-35. [DOI: 10.1089/met.2015.0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hyun Yoon
- Department of Biomedical Laboratory Science, Hanlyo University, Jeollanamdo, South Korea
| | - Seong Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
| | - So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Mi Ah Han
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, South Korea
| | - Gwang Seok Kim
- Emergency Medical Technology, Chungbuk Health and Science University, Chungcheongbukdo, South Korea
| | - Sung Gil Kim
- Department of Radiological Science, Hanlyo University, Jeollanamdo, South Korea
| | - Hye Jong Oh
- Department of Biomedical Laboratory Science, Hanlyo University, Jeollanamdo, South Korea
| | - Cheol Won Choi
- Department of Biomedical Laboratory Science, Hanlyo University, Jeollanamdo, South Korea
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