McDonagh Sinead T J, Norris Ben, Fordham A Jayne, Greenwood Maria R, Richards Suzanne H, Campbell John L, Clark Christopher E
Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine & Health, Exeter, UK.
Amicus Health - Clare House Surgery, Tiverton, UK.
BJGP Open. 2022 Sep 28;6(3). doi: 10.3399/BJGPO.2021.0242. Print 2022 Sep.
Systolic inter-arm differences (IAD) in blood pressure (BP) contribute independently to cardiovascular risk estimates. This can be used to refine predicted risk and guide personalised interventions.
To model the effect of accounting for IAD in cardiovascular risk estimation in a primary care population free of pre-existing cardiovascular disease.
DESIGN & SETTING: A cross-sectional analysis of people aged 40-75 years attending NHS Health Checks in one general practice in England.
Simultaneous bilateral BP measurements were made during health checks. QRISK2, atherosclerotic cardiovascular disease (ASCVD), and Framingham cardiovascular risk scores were calculated before and after adjustment for IAD using previously published hazard ratios. Reclassification across guideline-recommended intervention thresholds was analysed.
Data for 334 participants were analysed. Mean (standard deviation) QRISK2, ASCVD, and Framingham scores were 8.0 (6.9), 6.9 (6.5), and 10.7 (8.1), respectively, rising to 8.9 (7.7), 7.1 (6.7), and 11.2 (8.5) after adjustment for IAD. Thirteen (3.9%) participants were reclassified from below to above the 10% QRISK2 threshold, three (0.9%) for the ASCVD 10% threshold, and nine (2.7%) for the Framingham 15% threshold.
Knowledge of IAD can be used to refine cardiovascular risk estimates in primary care. By accounting for IAD, recommendations of interventions for primary prevention of cardiovascular disease can be personalised and treatment offered to those at greater than average risk. When assessing elevated clinic BP readings, both arms should be measured to allow fuller estimation of cardiovascular risk.
血压的收缩压双臂差异（IAD）独立地影响心血管风险评估。这可用于优化预测风险并指导个性化干预。
在无既往心血管疾病的基层医疗人群中，模拟在心血管风险评估中考虑IAD的效果。
对在英格兰一家全科诊所参加国民健康服务（NHS）健康检查的40 - 75岁人群进行横断面分析。
在健康检查期间同时进行双侧血压测量。使用先前公布的风险比，在调整IAD前后计算QRISK2、动脉粥样硬化性心血管疾病（ASCVD）和弗雷明汉心血管风险评分。分析跨指南推荐干预阈值的重新分类情况。
分析了334名参与者的数据。平均（标准差）QRISK2、ASCVD和弗雷明汉评分分别为8.0（6.9）、6.9（6.5）和10.7（8.1），调整IAD后分别升至8.9（7.7）、7.1（6.7）和11.2（8.5）。13名（3.9%）参与者从低于10%的QRISK2阈值重新分类为高于该阈值，3名（0.9%）为ASCVD 10%阈值，9名（2.7%）为弗雷明汉15%阈值。
IAD的信息可用于优化基层医疗中的心血管风险评估。通过考虑IAD，心血管疾病一级预防干预的建议可实现个性化，并为高于平均风险的人群提供治疗。在评估诊室血压读数升高时，应测量双臂以更全面地评估心血管风险。
