title: Four-limb blood pressure as predictors of mortality in elderly Chinese.
abstract: The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P≤0.01) and 1.17 to 1.24 for cardiovascular mortality (P≤0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (≤0.90, ≤0.95, or ≤1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.
authors.affiliation: The Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. jiguangw@gmail.com
authors.forename: Chang-Sheng
authors.initials: CS
authors.lastname: Sheng
authors.forename: Ming
authors.initials: M
authors.lastname: Liu
authors.forename: Wei-Fang
authors.initials: WF
authors.lastname: Zeng
authors.forename: Qi-Fang
authors.initials: QF
authors.lastname: Huang
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Ji-Guang
authors.initials: JG
authors.lastname: Wang
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology*; D002681:China / Q000453:epidemiology; D005121:Extremities; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Chinese; ankle-brachial index; elderly; interankle blood pressure difference; interarm blood pressure difference; mortality