Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, UK.
Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, Devon, UK.
Lancet. 2012 Mar 10;379(9819):905-914. doi: 10.1016/S0140-6736(11)61710-8. Epub 2012 Jan 30.
Differences in systolic blood pressure (SBP) of 10 mm Hg or more or 15 mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. We investigated whether an association exists between this difference and central or peripheral vascular disease, and mortality.
We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, and Medline In Process databases for studies published before July, 2011, showing differences in SBP between arms, with data for subclavian stenosis, peripheral vascular disease, cerebrovascular disease, cardiovascular disease, or survival. We used random effects meta-analysis to combine estimates of the association between differences in SBP between arms and each outcome.
We identified 28 eligible studies for review, 20 of which were included in our meta-analyses. In five invasive studies using angiography, mean difference in SBP between arms was 36·9 mm Hg (95% CI 35·4-38·4) for proven subclavian stenosis (>50% occlusion), and a difference of 10 mm Hg or more was strongly associated with subclavian stenosis (risk ratio [RR] 8·8, 95% CI 3·6-21·2). In non-invasive studies, pooled findings showed that a difference of 15 mm Hg or more was associated with peripheral vascular disease (nine cohorts; RR 2·5, 95% CI 1·6-3·8; sensitivity 15%, 9-23; specificity 96%, 94-98); pre-existing cerebrovascular disease (five cohorts; RR 1·6, 1·1-2·4; sensitivity 8%, 2-26; specificity 93%, 86-97); and increased cardiovascular mortality (four cohorts; hazard ratio [HR] 1·7, 95% CI 1·1-2·5) and all-cause mortality (HR 1·6, 1·1-2·3). A difference of 10 mm Hg or higher was associated with peripheral vascular disease (five studies; RR 2·4, 1·5-3·9; sensitivity 32%, 23-41; specificity 91%, 86-94).
A difference in SBP of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death.
Royal College of General Practitioners, South West GP Trust, and Peninsula Collaboration for Leadership in Applied Health Research and Care.
手臂之间收缩压（SBP）差异超过 10mmHg 或 15mmHg 与外周血管疾病有关，并归因于锁骨下狭窄。我们研究了这种差异与中心或外周血管疾病以及死亡率之间是否存在关联。
我们在 2011 年 7 月之前，在 Medline、Embase、累积索引护理和联合健康文献、Cochrane 和 Medline 处理数据库中搜索了显示手臂之间 SBP 差异的研究，以及锁骨下狭窄、外周血管疾病、脑血管疾病、心血管疾病或生存的数据。我们使用随机效应荟萃分析来合并手臂之间 SBP 差异与每个结果之间关联的估计值。
我们确定了 28 项进行审查的合格研究，其中 20 项被纳入我们的荟萃分析。在五项使用血管造影的有创研究中，手臂之间 SBP 的平均差异为 36.9mmHg（95%CI 35.4-38.4），证实存在锁骨下狭窄（>50%闭塞），差异超过 10mmHg 与锁骨下狭窄强烈相关（风险比 [RR]8.8，95%CI 3.6-21.2）。在非侵入性研究中，汇总结果表明，差异超过 15mmHg 与外周血管疾病相关（9 个队列；RR 2.5，95%CI 1.6-3.8；灵敏度 15%，9-23；特异性 96%，94-98）；存在预先存在的脑血管疾病（5 个队列；RR 1.6，1.1-2.4；灵敏度 8%，2-26；特异性 93%，86-97）；和增加的心血管死亡率（4 个队列；危险比 [HR]1.7，95%CI 1.1-2.5）和全因死亡率（HR 1.6，1.1-2.3）。差异超过 10mmHg 与外周血管疾病相关（5 项研究；RR 2.4，1.5-3.9；灵敏度 32%，23-41；特异性 91%，86-94）。
手臂之间的 SBP 差异超过 10mmHg 或超过 15mmHg 可能有助于识别需要进一步血管评估的患者。差异超过 15mmHg 可能是血管疾病和死亡风险的有用指标。
皇家全科医师学院、西南 GP 信托基金和半岛合作领导应用健康研究和护理。
