title: Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease.
abstract: OBJECTIVE
  Recent studies have shown that inter-arm blood pressure differences (IAD) may be a risk factor for cardiovascular events; however, none have addressed them in patients with coronary artery disease (CAD).
  
  
  METHODS
  We measured blood pressure bilaterally with the ankle brachial index (ABI) in 657 patients with suspected CAD and assessed the presence of CAD by coronary angiography, and the severity of coronary atherosclerosis with the Gensini score.
  
  
  RESULTS
  Mean IADs were significantly greater in risk factor matched patients with CAD than in those without it (P = 0.01), whereas Gensini scores were significantly greater in those with high IAD (≥10  mmHg) than in those with low-IAD (P = 0.01) according to cross-sectional analysis. Patients with high IAD had a significantly greater probability of cardiovascular events than those in whom it was low (log-rank test, P < 0.01, mean follow-up range; 827.3 ± 268.1 days). The presence of hypertension, ABI, usage of calcium channel blocker and high IAD were independent predictors of cardiovascular events according to longitudinal analysis (IAD; hazard ratio: 2.90, 95% confidence interval: 1.41-5.94, P < 0.01) in these patients. Patients with high IAD and peripheral artery disease had the highest Gensini scores according to cross-sectional analysis (P < 0.01) and highest probability of cardiovascular events according to longitudinal analysis (log-rank test, P < 0.001).
  
  
  CONCLUSIONS
  IADs were increased in CAD patients and correlated with its severity. Greater than 10  mmHg of IAD was independently associated with future cardiovascular events. Assessing IAD by ABI measurement may facilitate risk stratification in CAD patients.
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Tokitsu
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hirata
authors.forename: Koichiro
authors.initials: K
authors.lastname: Fujisue
authors.forename: Koichi
authors.initials: K
authors.lastname: Sugamura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Maeda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tsujita
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001132:Arm; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D002121:Calcium Channel Blockers