Simultaneously measured interarm blood pressure difference and stroke: An individual participants data meta-analysis

Hirofumi Tomiyama, Toshiaki Ohkuma, Toshiharu Ninomiya, Chisa Mastumoto, Kazuomi Kario, Satoshi Hoshide, Yoshikuni Kita, Toyoshi Inoguchi, Yasutaka Maeda, Katsuhiko Kohara, Yasuharu Tabara, Motoyuki Nakamura, Takayoshi Ohkubo, Hirotaka Watada, Masanori Munakata, Mitsuru Ohishi, Norihisa Ito, Michinari Nakamura, Tetsuo Shoji, Charalambos VlachopoulosAkira Yamashina

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


We conducted individual participant data meta-analysis to examine the validity of interarm blood pressure difference in simultaneous measurement as a marker to identify subjects with ankle-brachial pressure index <0.90 and to predict future cardiovascular events. We collected individual participant data on 13 317 Japanese subjects from 10 cohorts (general population-based cohorts, cohorts of patients with past history of cardiovascular events, and those with cardiovascular risk factors). Binary logistic regression analysis with adjustments identified interarm blood pressure difference >5 mm Hg as being associated with a significant odds ratio for the presence of ankle-brachial pressure index <0.90 (odds ratio, 2.19; 95% confidence interval, 1.60-3.03; P<0.01). Among 11 726 subjects without a past history of cardiovascular disease, 249 developed stroke during the average follow-up period of 7.4 years. Interarm blood pressure difference >15 mm Hg was associated with a significant Cox stratified adjusted hazard ratio for subsequent stroke (hazard ratio, 2.42; 95% confidence interval, 1.27-4.60; P<0.01). Therefore, interarm blood pressure differences, measured simultaneously in both arms, may be associated with vascular damage in the systemic arterial tree. These differences may be useful for identifying subjects with an ankle-brachial pressure index of <0.90 in the overall study population, and also a reliable predictor of future stroke in subjects without a past history of cardiovascular disease. These findings support the recommendation to measure blood pressure in both arms at the first visit.

Original languageEnglish
Pages (from-to)1030-1038
Number of pages9
Issue number6
Publication statusPublished - 2018

All Science Journal Classification (ASJC) codes

  • Internal Medicine


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