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Negative Outcomes Associated with Inter-arm Systolic Blood Pressure Differences in Diabetes Patients

Inter-arm systolic blood pressure differences may be a sign of bad things to come….

In hypertensive patients, inter-arm differences in blood pressure have been associated with not only vascular disease but also an increased mortality. To find out if the same was true in patients with diabetes, Dr. Christopher Clark, Ph.D., and colleagues at the University of Exeter, United Kingdom assessed the association between inter-arm blood pressure differences and the risk of cardiovascular morbidity and mortality in 727 patients with type 1 or type 2 diabetes and compared it to 285 non-diabetic control subjects.

Diabetic patients having an inter-arm systolic blood pressure difference of 10mmHg or greater were found to have an increased risk of peripheral artery disease (Odds ratio=3.4, CI 95%, 1.2 to 9.3)

In patients having inter-arm differences of ≥15mmHg were found to have an increased risk of diabetic retinopathy (OR=5.7, CI 95%, 1.5 to 21.6). Further, these patients were also at an increased risk of chronic kidney disease (OR= 7; CI 95%, 1.7 to 29.8).

Cardiovascular mortality was also found to be higher in diabetic patients with inter-arm differences in systolic BP. In patients with inter-arm blood pressure difference of ≥10mmHg had a hazard ratio of 3.5, (CI 95%, 1 to 13). In those with inter-arm blood pressure difference of ≥15 mmHg or greater, hazard ratio was 9 (CI 95%, 2 to 41).

The association between inter-arm differences and negative vasculature outcomes suggests that a subpopulation of those at increased risk of vasculature events may need to be defined. More studies are necessary to determine if more stringent goals are needed in this patient population and what interventions are most beneficial for reducing the associated morbidity and mortality.

Practice Pearls:
  • Diabetic patients with an inter-arm systolic blood pressure difference may be at an increased risk of morbidity and mortality
  • Inter-arm systolic blood pressure differences were associated with the presence of retinopathy, peripheral artery disease and chronic kidney disease
  • Health care providers should be aware of these potential risks and their potential long-term implications on vasculature health 

Clark CE, Steele AM, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Interarm Blood Pressure Difference in People With Diabetes: Measurement and Vascular and Mortality Implications: A Cohort Study. Diabetes Care. April, 2014; 37(4)