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Abstract：
BACKGROUND: Bilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm.
METHODS: This sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results).
RESULTS: We included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32-1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140-159/90-99 mmHg (OR 1.68, 95% CI 1.44-1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49-2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm.
CONCLUSIONS: Female sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening.
UNASSIGNED: NCT03395509:10/12/2018.
METHODS: This sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results).
RESULTS: We included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32-1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140-159/90-99 mmHg (OR 1.68, 95% CI 1.44-1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49-2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm.
CONCLUSIONS: Female sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening.
UNASSIGNED: NCT03395509:10/12/2018.
摘要：
背景：双侧血压（BP）测量在心血管预防中对于识别收缩期臂间血压差（IAD）和高血压很重要。我们调查了性别分层的IAD患病率及其与筛查检测到的外周动脉粥样硬化和高血压的关联和共存。此外，我们确定了使用较低和较高阅读臂时错误分类为非高血压的比例.
方法：这项子研究是维堡筛查计划（VISP）的一部分，一项针对67岁丹麦人的跨部门人群心血管筛查计划.VISP包括筛查外周动脉粥样硬化（下肢动脉疾病和颈动脉斑块），腹主动脉瘤,高血压,糖尿病,和心脏病。自我报告的合并症，危险因素，还收集了药物使用情况。在4602名与会者中，4,517（82.1％）进行了合格的双边和重复BP测量。IAD定义为收缩压差值≥10mmHg。通过逻辑回归估计IAD相关因素（筛查结果和危险因素）；通过维恩图（筛查结果）显示比例共存。
结果：我们包括2,220名女性（49.2%）和2,297名男性（50.8%）。IAD在女性（26.8%）比男性（21.0%）更为明显（p<0.001）。调整后这种差异仍然存在[优势比（OR）1.53；95％置信区间（CI）1.32-1.77]。没有记录与筛选条件的其他关联，除非潜在高血压：BP140-159/90-99mmHg（OR1.68，95％CI1.44-1.97）和BP≥160/100mmHg（OR1.82，95％CI1.49-2.23）。总的来说,IAD和BP≥160/100mmHg共存的女性为4％，男性为5％；对于BP≥140/90mmHg，13%和14%，分别。在较高阅读臂中记录平均BP≥140/90mmHg的人中，与最低阅读臂相比，14.5％的女性和15.3％的男性会被错误分类为非高血压。
结论：女性是IAD患病率的独立因素，但与其他动脉病变无关。当使用较低而不是较高的阅读臂时，大约15％的人需要根据BP≥140/90mmHg进行重新分类；验证双侧BP测量结果可改善对潜在高血压的检测。在未来,应评估性别分层IAD对心血管事件和死亡的预测价值,以验证其作为人群心血管筛查筛查工具的潜力.
■NCT03395509:2018年10月12日。
方法：这项子研究是维堡筛查计划（VISP）的一部分，一项针对67岁丹麦人的跨部门人群心血管筛查计划.VISP包括筛查外周动脉粥样硬化（下肢动脉疾病和颈动脉斑块），腹主动脉瘤,高血压,糖尿病,和心脏病。自我报告的合并症，危险因素，还收集了药物使用情况。在4602名与会者中，4,517（82.1％）进行了合格的双边和重复BP测量。IAD定义为收缩压差值≥10mmHg。通过逻辑回归估计IAD相关因素（筛查结果和危险因素）；通过维恩图（筛查结果）显示比例共存。
结果：我们包括2,220名女性（49.2%）和2,297名男性（50.8%）。IAD在女性（26.8%）比男性（21.0%）更为明显（p<0.001）。调整后这种差异仍然存在[优势比（OR）1.53；95％置信区间（CI）1.32-1.77]。没有记录与筛选条件的其他关联，除非潜在高血压：BP140-159/90-99mmHg（OR1.68，95％CI1.44-1.97）和BP≥160/100mmHg（OR1.82，95％CI1.49-2.23）。总的来说,IAD和BP≥160/100mmHg共存的女性为4％，男性为5％；对于BP≥140/90mmHg，13%和14%，分别。在较高阅读臂中记录平均BP≥140/90mmHg的人中，与最低阅读臂相比，14.5％的女性和15.3％的男性会被错误分类为非高血压。
结论：女性是IAD患病率的独立因素，但与其他动脉病变无关。当使用较低而不是较高的阅读臂时，大约15％的人需要根据BP≥140/90mmHg进行重新分类；验证双侧BP测量结果可改善对潜在高血压的检测。在未来,应评估性别分层IAD对心血管事件和死亡的预测价值,以验证其作为人群心血管筛查筛查工具的潜力.
■NCT03395509:2018年10月12日。
