Interarm blood pressure difference in people with diabetes: measurement and vascular and mortality implications: a cohort study

2.50
Hdl Handle:
http://hdl.handle.net/11287/593868
Title:
Interarm blood pressure difference in people with diabetes: measurement and vascular and mortality implications: a cohort study
Authors:
Clark, C. E.; Steele, A. M.; Taylor, R. S.; Shore, Angela ( 0000-0003-3039-308x ) ; Ukoumunne, Obiaha C.; Campbell, J. L.
Abstract:
OBJECTIVE: Differences in blood pressure between arms are associated with vascular disease and increased mortality; this has not been reported in diabetes. We explored these associations, and assessed reference standard and pragmatic measurement techniques, in people with diabetes and in nondiabetic controls. RESEARCH DESIGN AND METHODS: A prospective cohort study in Devon, England, recruited 727 people with type 1 or type 2 diabetes and 285 nondiabetic controls. Simultaneous repeated measurements of bilateral blood pressure were made at recruitment. Data were used to inform a pragmatic measurement strategy. Interarm differences were examined for cross-sectional associations with target organ disease and prospective mortality associations (median follow-up 52 months). RESULTS: We found 8.6% of participants with diabetes and 2.9% of controls had systolic interarm differences >/=10 mmHg. Single pairs of blood pressure measurements had high negative predictive values (97-99%) for excluding interarm differences. Systolic interarm differences >/=10 mmHg in diabetes were associated with peripheral arterial disease (odds ratio [OR] 3.4 [95% CI 1.2-9.3]). Differences >/=15 mmHg were associated with diabetic retinopathy (OR 5.7 [1.5-21.6]) and chronic kidney disease (OR 7.0 [1.7-29.8]). Systolic interarm differences were associated prospectively with increased cardiovascular mortality: hazard ratios 3.5 (1.0-13.0) for >/=10 mmHg and 9.0 (2.0-41.0) for >/=15 mmHg. CONCLUSIONS: Blood pressure should be measured in both arms during initial assessment in diabetes. Systolic interarm differences can be excluded with a single pair of measurements. In the population with diabetes, systolic differences may be associated with an increased risk of morbidity and mortality.
Citation:
Diabetes Care. 2014 Jun;37(6):1613-20.
Publisher:
Diabetes Care
Journal:
Diabetes care
Issue Date:
1-Jun-2014
URI:
http://hdl.handle.net/11287/593868
DOI:
10.2337/dc13-1576
PubMed ID:
24667458
Additional Links:
http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=24667458
Type:
Journal Article; Comparative Study; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1935-5548
Appears in Collections:
Vascular Surgery; 2014 RD&E publications; Cardiology; Honorary contracts publications

Full metadata record

DC FieldValue Language
dc.contributor.authorClark, C. E.en
dc.contributor.authorSteele, A. M.en
dc.contributor.authorTaylor, R. S.en
dc.contributor.authorShore, Angelaen
dc.contributor.authorUkoumunne, Obiaha C.en
dc.contributor.authorCampbell, J. L.en
dc.date.accessioned2016-01-19T12:36:02Zen
dc.date.available2016-01-19T12:36:02Zen
dc.date.issued2014-06-01en
dc.identifier.citationDiabetes Care. 2014 Jun;37(6):1613-20.en
dc.identifier.issn1935-5548en
dc.identifier.pmid24667458en
dc.identifier.doi10.2337/dc13-1576en
dc.identifier.urihttp://hdl.handle.net/11287/593868en
dc.description.abstractOBJECTIVE: Differences in blood pressure between arms are associated with vascular disease and increased mortality; this has not been reported in diabetes. We explored these associations, and assessed reference standard and pragmatic measurement techniques, in people with diabetes and in nondiabetic controls. RESEARCH DESIGN AND METHODS: A prospective cohort study in Devon, England, recruited 727 people with type 1 or type 2 diabetes and 285 nondiabetic controls. Simultaneous repeated measurements of bilateral blood pressure were made at recruitment. Data were used to inform a pragmatic measurement strategy. Interarm differences were examined for cross-sectional associations with target organ disease and prospective mortality associations (median follow-up 52 months). RESULTS: We found 8.6% of participants with diabetes and 2.9% of controls had systolic interarm differences >/=10 mmHg. Single pairs of blood pressure measurements had high negative predictive values (97-99%) for excluding interarm differences. Systolic interarm differences >/=10 mmHg in diabetes were associated with peripheral arterial disease (odds ratio [OR] 3.4 [95% CI 1.2-9.3]). Differences >/=15 mmHg were associated with diabetic retinopathy (OR 5.7 [1.5-21.6]) and chronic kidney disease (OR 7.0 [1.7-29.8]). Systolic interarm differences were associated prospectively with increased cardiovascular mortality: hazard ratios 3.5 (1.0-13.0) for >/=10 mmHg and 9.0 (2.0-41.0) for >/=15 mmHg. CONCLUSIONS: Blood pressure should be measured in both arms during initial assessment in diabetes. Systolic interarm differences can be excluded with a single pair of measurements. In the population with diabetes, systolic differences may be associated with an increased risk of morbidity and mortality.en
dc.language.isoengen
dc.publisherDiabetes Careen
dc.relation.urlhttp://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=24667458en
dc.titleInterarm blood pressure difference in people with diabetes: measurement and vascular and mortality implications: a cohort studyen
dc.typeJournal Articleen
dc.typeComparative Studyen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalDiabetes careen

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