The association of four-limb blood pressure differences with cardiovascular risk factors and target organ changes in elderly Chinese: The Northern Shanghai Study

ABSTRACT

Background: The association of four-limb systolic blood pressure differences (SBPDs) including inter-arm (IASBPD), inter-leg (ILSBPD) and ankle-brachial index (ABI) with cardiovascular risk factors and target organ changes (TOCs) remains controversial. This study aims at investigating the association of those parameters with cardiovascular risk factors and TOCs in an elderly Chinese population.

Methods: A total of 1528 subjects derived from the Northern Shanghai Study were studied. Four-limb BPs were simultaneously measured by VP-1000 device. Cardiovascular risk factors and TOCs including parameters of left ventricular structure and function, carotid intima-media thickness, carotid-femoral pulse-wave velocity (CF-PWV), estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio, were evaluated with standardized methods.

Results: ABI significantly associated age (β = −0.004, p < .01), female gender (β = 0.02, p < .01), body mass index (β = −0.004, p < .01), smoking (β = −0.04, p < .01), high-density lipoprotein (β = 0.04, p < .01), low-density lipoprotein (β = −0.01, p = .01) and diabetes mellitus (β = −0.02, p < .01), while the fourth root of IASBPD significantly associated with body mass index (β = 0.03, p < .01), high-density lipoprotein (β = −0.10, p = .02) and brachial SBP (β = 0.003, p < .01); the fourth root of ILSBPD significantly associated with high-density lipoprotein (β = −0.12, p < .01) and diabetes mellitus (β = 0.09, p = .01). IASBPD, ILSBPD, and ABI all significantly associated with CF-PWV and eGFR (all p < .05) in either unadjusted or adjusted models, but not with other TOCs.

Conclusion: Four-limb SBPDs, namely ABI, IASBPD, and ILSBPD, bore various burdens of cardiovascular risk factors and significantly and independently associated with CF-PWV and eGFR.

KEYWORDS:

• Inter-arm blood pressure difference
• inter-leg blood pressure difference
• ankle-brachial index
• cardiovascular risk factor
• target organ changes

Acknowledgments

We thank all the investigators, staff, and participants involved in this study for their great assistance and cooperation. We also thank Abdul Quddus Mohammed for his help in language revision. This work was supported by the National Key Research and Development under Grant 2017YFC0111800 and the Shanghai Municipal Government under Grant 2013ZYJB0902 and 15GWZK1002. Dr. Yi Zhang was supported by the National Nature Science Foundation of China (Grant ID. 81300239; 81670377)

Disclosure of interest

The authors report no conflict of interest.