Study On The Inter-arm Blood Pressure Difference Of Healthy People And Patients With Hypertension And Diabetes

Background:Blood pressure difference between arms is generally existed in the population, and the difference is significant in several types of people. In recent years, more and more researchers pay attention to this phenomenon, and they call it “inter-arm blood pressure difference”(IAD). The IAD includes the inter-arm systolic blood pressure difference(s IAD) and the inter-arm diastolic blood pressure difference(d IAD). Studies have been carried out about IAD. At present, most studies have shown that IAD is related to diabetes, hypertension, coronary heart disease and stroke, and it is important to predict the incidence and mortality of cardiovascular and cerebrovascular disease.Objectives: To investigate the magnitude of the IAD among citizens and measure prevalence of IAD>10mm Hg in examination clients, HP patients,and DM patients.Methods:1. We enrolled 783 citizens receiving physical examination in the Jiangwan Hospital of Shanghai Hongkou District from June, 2014 to June, 2015. The subjects were with an average age 65.10±13.41, 379 men and 404 women).2. All subjects have sinus rhythm. People with atrial fibrillation, congenital heart disease, severe heart failure, paralysis, too thick of upper arm circumference and pulseless were excluded.3. Blood pressure measuring method: A casual BP reading was measured twice in a sitting position after a 10 minutes rest, using an automated electronic sphygmomanometer(Omron HEM-7220). Elbows should be at the same height of heart. All blood pressure measurements were non-invasive and were performed using the same new 2 machines, which were calibrated and marked 1 and 2.4. General information including age, gender, history of diabetes and high blood pressure(HBP) were recorded.5. The number of different age, gender groups of HBP and diabetes in each age group were analyzed. Blood pressure were compared in the groups, according to gender and age in the different group. IAD were compared in the groups, according to blood pressure and diabetes history in the different group.6. We defined for IAD was the absolute difference in blood pressure between arms, and p<0.05 was regarded with statistical significance.Results:1. In 196 cases of healthy individuals without hypertension or diabetes, the s IAD was 4.41±2.84 mm Hg, the d IAD was 3.39±3.59 mm Hg, with the incidence rate of s IAD≥10mm Hg at 5.61%, and the incidence rate of d IAD≥10mm Hg at 3.57%; and the differences of the incidence rates of abnormal s IAD and d IAD among different age groups were not statistically significant.(P>0.05)2. In 404 cases of patients with simple hypertension, the s IAD was 5.65±5.03 mm Hg, the d IAD was 4.04±3.59 mm Hg, and the differences of the s IAD and the d IAD compared with the healthy group were both statistically significant(t=-3.57, P<0.0001; t=-2.39, P=0.02); in the hypertension group, the incidence rate of s IAD≥10mm Hg was 11.25%, and the incidence rate of d IAD≥10mm Hg was 4.11%, the differences between the incidence rates of abnormal s IAD and d IAD compared with the healthy group were statistically significant(respectively: X2=11.25, P=0.001; X2=4.11, P=0.04), and the differences of the incidence rates of abnormal d IAD among different age groups were also statistically significant.(X2=6.56, P=0.04)3. In 106 cases of patients with simple diabetes, the s IAD was 6.72±5.76 mm Hg, the d IAD was 5.19±4.45 mm Hg, and the differences of the s IAD and the d IAD compared with the healthy group were both statistically significant(t=-3.55, P<0.0001; t=-3.03, P=0.003); in the diabetes group, the incidence rate of s IAD≥10mm Hg was 16.98%, and the incidence rate of d IAD≥10mm Hg was 11.32%; compared with the results of the healthy group, the incidence rates of the s IAD and the d IAD were both statistically significant.(respectively: X2=10.24, P=0.001; X2=7.01, P=0.01)4. In 77 cases of patients with hypertension and diabetes, the s IAD was 7.23±7.91 mm Hg, the d IAD was 4.14±4.08 mm Hg, with the incidence rate of s IAD≥10mm Hg at 15.58%, and the incidence rate of d IAD≥10mm Hg at 3.90%; compared with the results of the healthy group, there was statistical significance of the difference of the results of the s IAD(t=-4.82, P<0.0001), also the),there was statistical significance of the difference of the incidence rates of abnormal s IAD between the two groups(X2=7.13, P=0.01); the differences of the incidence rates of abnormal s IAD and d IAD were not statistically significant either between the hypertension & diabetes group and the diabetes group or between the hypertension & diabetes group and the hypertension group.5. According to the results of multiple linear regression analysis: with the increase of the age, the results of the s IAD and the d IAD also increased, and the s IAD and the d IAD of the patients with the history of diabetes or hypertension were higher than healthy people; the d IAD values were higher in women than in man, while the gender difference was not a significant factor of influence for the s IAD.Conclusions:1. As IAD is not uncommon in healthy population, care should be taken to measure blood pressure measurement for both arms in clinical practice.2. Patients with simple hypertension, simple diabetes or hypertension combined with diabetes tend to have greater incidence of abnormal IAD than do healthy population, and abnormal d IAD would increase with age in patients with simple hypertension. Active blood pressure and blood glucose control is therefore particularly important for hypertensive and diabetic patients. For hypertensive patients, greater attention should be paid to active control of the cardio- and cerebrovascular risk factors with increasing age, and to improve the vascular conditions and prevent further vascular sclerosis and stenosis in an effort to reduce the risk of long-term cardiovascular events.3. With the increase of the age, the results of the s IAD and the d IAD also increased, and the s IAD and the d IAD of the patients with the history of diabetes or hypertension were higher than healthy people; the d IAD values were higher in women than in man, while the gender difference was not a significant factor of influence for the s IAD. These results indicated that we should not only pay attention to diabetic patients and hypertensive patients, but also the middle-aged and elderly population, especially the difference of the arm blood pressure in middle-aged and elderly female patients.