Association between four-limb blood pressure differences and arterial stiffness: a cross-sectional study

ABSTRACT

Objectives

Although inter-arm blood pressure difference (IAD) and inter-ankle blood pressure difference (IAND) have been shown to be associated with cardiovascular disease, controversy remains. In this study, we investigated the prevalence of IAD and IAND as well as the correlation with arterial stiffness and systolic blood pressure in a large number of the Chinese population.

Methods

The four-limb blood pressure, IAD, IAND, brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) of 12,176 participants have been measured. Multivariate logistic regression analysis was used to analyze the relationship of the increase in IAD/IAND with arterial stiffness and blood pressure. Reporting adheres to the STROBE guidelines.

Results

In 12,176 participants, 1832 (15%) subjects had an IAD≥10 mmHg, 663 (5%) had an IAD≥15 mmHg, and 291 (2%) had an IAD≥20 mmHg. Correspondingly, 4548 (37%) had an IAND≥10 mmHg, 2706 (22%) had an IAND≥15 mmHg, and 1706 (14%) had an IAND≥20 mmHg. baPWV was significantly higher in those with an IAD≥10 mmHg (1881 ± 487 cm/s vs. 1943 ± 508 cm/s, P = 0.036) and IAND≥10 mmHg (1850 ± 476 cm/s vs. 1955 ± 509 cm/s, P = 0.000). Compared to others, those with IAD or IAND≥10 mmHg had higher systolic blood pressure (SBP), higher prevalence of hypertension, larger male gender ratio, bigger body mass index, higher pulse rate and lower ABI (P < 0.001 for all). A significant association with baPWV was observed for IAND≥10 mmHg (OR = 1.117; 95%CI: 1.039–1.201; P = 0.003) not for IAD≥10 mmHg (OR = 0.771; 95%CI: 0.699–0.851; P = 0.000) in multivariate logistic regression analysis.

Conclusions

Limb blood pressure differences were closely related to arterial stiffness and systolic blood pressure, allowing for a more comprehensive assessment of cardiovascular risk.

KEYWORDS:

• Inter-arm blood pressure difference
• inter-ankle blood pressure difference
• arterial stiffness
• brachial-ankle pulse wave velocity
• blood pressure

Acknowledgments

The authors would like to thank all the participants and medical staff who contributed to this study.

Author contributions

YWH conceived the study, made the design, performed the statistical analyses, and drafted the manuscript. HY and GLL participated in the design and statistic work. GLL and XXC collected data. GT and YL revised the paper. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Declaration of funding

The present study was financially supported by the National Natural Science Foundation of China [grant number 81,860,055]; and the Department of Science and Technology of Yunnan Province-Kunming Medical University Joint Research Project [grant number 2019FE001(−100)]; and the High-level scientific and technological talent project in Yunnan Province [grant number 202005AC160070]. The funders had no role in the study design, data collection and analysis and preparation of the manuscript.

Declaration of conflicting interests

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.