@article {Clarke297, author = {Christopher E Clark and Rod S Taylor and Isabella Butcher and Marlene CW Stewart and Jackie Price and F Gerald R Fowkes and Angela C Shore and John L Campbell}, title = {Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk}, volume = {66}, number = {646}, pages = {e297--e308}, year = {2016}, doi = {10.3399/bjgp16X684949}, publisher = {Royal College of General Practitioners}, abstract = {Background Differences in blood pressure between arms are associated with increased cardiovascular mortality in cohorts with established vascular disease or substantially elevated cardiovascular risk.Aim To explore the association of inter-arm difference (IAD) with mortality in a community-dwelling cohort that is free of cardiovascular disease.Design and setting Cohort analysis of a randomised controlled trial in central Scotland, from April 1998 to October 2008.Method Volunteers from Lanarkshire, Glasgow, and Edinburgh, free of pre-existing vascular disease and with an ankle-brachial index <=0.95, had systolic blood pressure measured in both arms at recruitment. Inter-arm blood pressure differences were calculated and examined for cross-sectional associations and differences in prospective survival. Outcome measures were cardiovascular events and all-cause mortality during mean follow-up of 8.2 years.Results Based on a single pair of measurements, 60\% of 3350 participants had a systolic IAD >=5 mmHg and 38\% >=10 mmHg. An IAD >=5 mmHg was associated with increased cardiovascular mortality (adjusted hazard ratio [HR] 1.91, 95\% confidence interval [CI] = 1.19 to 3.07) and all-cause mortality (adjusted HR 1.44, 95\% CI = 1.15 to 1.79). Within the subgroup of 764 participants who had hypertension, IADs of >=5 mmHg or >=10 mmHg were associated with both cardiovascular mortality (adjusted HR 2.63, 95\% CI = 0.97 to 7.02, and adjusted HR 2.96, 95\% CI = 1.27 to 6.88, respectively) and all-cause mortality (adjusted HR 1.67, 95\% CI = 1.05 to 2.66, and adjusted HR 1.63, 95\% CI = 1.06 to 2.50, respectively). IADs >=15 mmHg were not associated with survival differences in this population.Conclusion Systolic IADs in blood pressure are associated with increased risk of cardiovascular events, including mortality, in a large cohort of people free of pre-existing vascular disease.}, issn = {0960-1643}, URL = {https://bjgp.org/content/66/646/e297}, eprint = {https://bjgp.org/content/66/646/e297.full.pdf}, journal = {British Journal of General Practice} }