학술논문
Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration
Document Type
article
Author
Clark, Christopher E; Warren, Fiona C; Boddy, Kate; McDonagh, Sinéad TJ; Moore, Sarah F; Teresa Alzamora, Maria; Ramos Blanes, Rafel; Chuang, Shao-Yuan; Criqui, Michael H; Dahl, Marie; Engström, Gunnar; Erbel, Raimund; Espeland, Mark; Ferrucci, Luigi; Guerchet, Maëlenn; Hattersley, Andrew; Lahoz, Carlos; McClelland, Robyn L; McDermott, Mary M; Price, Jackie; Stoffers, Henri E; Wang, Ji-Guang; Westerink, Jan; White, James; Cloutier, Lyne; Taylor, Rod S; Shore, Angela C; McManus, Richard J; Aboyans, Victor; Campbell, John L
Source
Hypertension. 79(10)
Subject
Language
Abstract
BackgroundGuidelines 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.MethodsOne-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.ResultsWe 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