Paiva Annelise M G, Gomes Maria I C M, Gomes Alana C M, Gomes Lucca C M, Ramalho Saulo R, Feitosa Audes D M, Malachias Marcus V B, Brandão Andréa A, Sposito Andrei C, Mota-Gomes Marco A, Nadruz Wilson
Centro de Pesquisas Clínicas do Centro Universitário Cesmac, Maceió, AL.
Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP.
J Hypertens. 2025 Feb 1;43(2):264-270. doi: 10.1097/HJH.0000000000003894. Epub 2024 Sep 30.
Interarm systolic blood pressure difference (IASD) values >15 mmHg (IASD > 15) are associated with increased cardiovascular risk, yet the underlying mechanisms remain unclear. This report evaluated whether IASD >15, assessed by different protocols [sequential or simultaneous; based on one or several blood pressure (BP) readings], was associated with adverse left ventricular (LV) remodeling.
This cross-sectional study evaluated 605 individuals who underwent clinical and echocardiography evaluation and three pairs of simultaneous arm BP readings. IASD was estimated by seven distinct protocols (three simultaneous and four sequential BP measurements criteria).
The cohort had a mean age of 53.5 ± 15.4 years, with 51% being women, 23% with LV hypertrophy, 14% with LV concentricity, 69% with normal geometry, 8% with concentric remodeling, 17% with eccentric hypertrophy and 6% with concentric hypertrophy. Multivariable logistic regression revealed that IASD >15 defined by simultaneous measures of the last two pairs of BP readings (IASDsim2) and sequential arm BP readings (right-left-right arm sequence; IASDseq3) were related to LV concentricity (odds ratio [95% CI] = 3.24 [1.02-10.28], P = 0.046 and 2.56 [1.09-6.00], P = 0.030, respectively) and LV concentric remodeling (odds ratio [95% CI] = 4.12 [1.08-15.78], P = 0.039 and 4.16 [1.61-10.76], P = 0.003, respectively). Conversely, IASD >15 defined by any criteria showed no association with LV hypertrophy.
Individuals with IASD >15 defined by IASDsim2 and IASDseq3 are associated with adverse LV remodeling, namely LV concentricity and LV concentric remodeling. These findings suggest that both criteria might be potentially used to preferentially assess abnormal IASD in the setting of clinical practice.
双臂收缩压差值（IASD）>15 mmHg（IASD>15）与心血管风险增加相关，但其潜在机制仍不清楚。本报告评估了通过不同方案（连续或同时测量；基于一次或多次血压读数）评估的IASD>15是否与不良左心室（LV）重构相关。
这项横断面研究评估了605名接受临床和超声心动图评估以及三对同时进行的上臂血压读数的个体。通过七种不同方案（三种同时测量和四种连续血压测量标准）估算IASD。
该队列的平均年龄为53.5±15.4岁，其中51%为女性，23%有左心室肥厚，14%有左心室向心性肥厚，69%几何形态正常，8%有向心性重构，17%有离心性肥厚，6%有同心性肥厚。多变量逻辑回归显示，由最后两对血压读数的同时测量（IASDsim2）和连续上臂血压读数（右-左-右臂顺序；IASDseq3）定义的IASD>15与左心室向心性肥厚（优势比[95%置信区间]=3.24[1.02-10.28]，P=0.046和2.56[1.09-6.00]，P=0.030）和左心室向心性重构（优势比[95%置信区间]=4.12[1.08-15.78]，P=0.039和4.16[1.61-10.76]，P=0.003）相关。相反，任何标准定义的IASD>15均与左心室肥厚无关。
由IASDsim2和IASDseq3定义的IASD>15的个体与不良左心室重构相关，即左心室向心性肥厚和左心室向心性重构。这些发现表明，这两种标准可能都可用于在临床实践中优先评估异常的IASD。
