TitleInterarm differences in systolic blood pressure and mortality among US army veterans: aetiological associations and risk prediction in the Vietnam Experience Study.
Publication TypeJournal Article
Year of Publication2014
AuthorsWhite, J, Mortensen, LH, Kivimäki, M, Gale, CR, Batty, GD
JournalEur J Prev Cardiol
Volume21
Issue11
Pagination1394-400
Date Published2014 Nov
ISSN2047-4881
KeywordsAdult, Ankle Brachial Index, Biomarkers, Blood Glucose, Blood Pressure, Blood Sedimentation, Female, Humans, Hypertension, Lipids, Male, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Reproducibility of Results, Risk Assessment, Risk Factors, Systole, Time Factors, United States, Upper Extremity, Veterans Health, Vietnam Conflict
Abstract

BACKGROUND: Differences between the arms in systolic blood pressure (SBP) of ≥10 mmHg have been associated with an increased risk of mortality in patients with hypertensive and chronic renal disease. For the first time, we examined these relationships in a non-clinical population.

DESIGN: Cohort study.

METHODS: Participants were 4419 men (mean age 38.37 years) from the Vietnam Experience Study. Bilateral SBP and diastolic BP (DBP), serum lipids, fasting glucose, erythrocyte sedimentation rate, metabolic syndrome, and ankle brachial index were assessed in 1986.

RESULTS: Ten per cent of men had an interarm difference of ≥10 and 2.4% of ≥15 mmHg. A 15-year follow-up period gave rise to 246 deaths (64 from cardiovascular disease, CVD). Interarm differences of ≥10 mmHg were associated with an elevated risk of all-cause mortality (hazard ratio, HR, 1.49, 95% confidence interval, CI, 1.04-2.14) and CVD mortality (HR 1.93, 95% CI 1.01-3.69). After adjusting for SBP, DBP, lipids, fasting glucose, and erythrocyte sedimentation rate, associations between interarm differences of ≥10 mmHg and all-cause mortality (HR 1.35, 95% CI 0.94-1.95) and CVD mortality (1.62, 95% CI 0.84-3.14) were significantly attenuated.

CONCLUSIONS: In this non-clinical cohort study, interarm differences in SBP were not associated with mortality after accounting for traditional CVD risk factors. Interarm differences might not be valuable as an additional risk factor for mortality in populations with a low risk of CVD.

DOI10.1177/2047487313496193
Alternate JournalEur J Prev Cardiol
PubMed ID23818287
PubMed Central IDPMC3805466
Grant List / / British Heart Foundation / United Kingdom
MC_UP_A620_1015 / / Medical Research Council / United Kingdom
MC_UU_12011/2 / / Medical Research Council / United Kingdom
/ / Medical Research Council / United Kingdom
MC_U147585819 / / Medical Research Council / United Kingdom
MR/K026992/1 / / Medical Research Council / United Kingdom
MC_UP_A620_1014 / / Medical Research Council / United Kingdom
/ / Cancer Research UK / United Kingdom
MC_UU_12011/1 / / Medical Research Council / United Kingdom
WT087640MA / / Wellcome Trust / United Kingdom
G0400491 / / Medical Research Council / United Kingdom
MC_U147585824 / / Medical Research Council / United Kingdom