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Cardiovascular Disease |

Interarm Systolic BP Difference and Its Association With Cardiovascular Biomarkers and Biochemical Risk Factors

Neil Agarwal, BS; Shashi Agarwal*, MD
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St. George's University, St. George's, Grenada


Chest. 2012;142(4_MeetingAbstracts):128A. doi:10.1378/chest.1390188
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Abstract

SESSION TYPE: CAD/Coronary Syndromes Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Inter-arm difference (SIAD) in systolic blood pressure (BP) of more than 15 mm Hg is not uncommon. It is attributed to atherosclerotic peripheral vascular disease involving the subclavian arteries. It is associated with increased mortality and a reduced event free survival. The study was done to document any association between SIAD and laboratory measured cardiovascular markers/risk factors for atherosclerosis.

METHODS: We retrospectively reviewed laboratory results in 106 consecutive treated hypertensive patients. All patients had blood work done within three months. Laboratory values were considered abnormal as follows: TC (total cholesterol) >200 mg/dl, LDL (low density lipoprotein) >130, HDL (high density lipoprotein) <40, hsCRP (C-reactive protein) >3 mg/L, Homocysteine >15 umol/L, HbA1c >5.7, Uric Acid >7.2 mg/d and Vitamin D <30 ng/mL.

RESULTS: Of the 106 (66 male; 40 female) patients with hypertension (ages: 23 to 92), 72 (68%) had no inter-arm BP difference (NIAD) and 34 (32%) had SIAD. The CVS markers were abnormal as follows: TC: NIAD 36 (50%), SIAD 15 (44%); LDL: NIAD 18 (25%), SIAD 10 (29%); HDL: NIAD 18 (25%), SIAD 10 (29%); Homocysteine: NIAD 11 (15%), SIAD 6 (18%); HbA1c: NIAD 51 (71%), SIAD 25 (74%); Uric Acid: NIAD 15 (21%), SIAD 9 (26%); Vitamin D: NIAD 63 (88%), SIAD 28 (82%); CRP: NIAD 24 (33%), SIAD 18 (53%).

CONCLUSIONS: There was no difference in the presence of cardiovascular risk markers in hypertensive patients with or without SIAD, except for CRP. CRP was elevated in disproportionately more patients with IAD. This supports the strong role played by inflammation in the development of atherosclerosis and the resultant SIAD in these patients.

CLINICAL IMPLICATIONS: Patients with elevated CRP are more likely to develop upper extremity atherosclerosis. This can be easily diagnosed by an inter-arm blood pressure difference of more than 15 mm Hg.

DISCLOSURE: The following authors have nothing to disclose: Neil Agarwal, Shashi Agarwal

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St. George's University, St. George's, Grenada

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