Inter-Arm Blood Pressure Difference And Mortality - Epidemiology Of Hypertension In Croatia (Ehuh Study)

Objective: Inter-arm blood pressure (BP) difference is associated with higher cardiovascular (CV) risk and increased mortality. The aim of this study was to obtain data on prevalence of inter-arm difference and association with all-caused and cardiovascular (CV) mortality in a random sample of Croatian general population. Design and method: EHUH study is nation-wide survey on prevalence, treatment and control of hypertension in Croatia. In 2001–2003 a random sample of 1267 subjects (men 40.8% mean age 53.1) were enrolled. Mortality data were analyzed after average period of 17 years. Office blood pressure (BP) was measured in sitting position using mercury sphygmomanometer three times at two visits and once at home visit: total 9 measurements -average BP values were calculated. Optimal, normal, high normal BP, untreated and treated hypertension (HT) were diagnosed in 20.9%, 15.3%, 12.9%, 19.1% and 31.5%, respectively During the first visit BP was measured at both arms. Subjects were divided into 2 groups: individuals with inter-arm BP difference of 10 mmHg or more and those with lesser difference Mortality data were collected from National Public Health Institute records. Results: In the whole group inter-arm difference was found in 23.4% subjects (m22.7% vs w 15.8%; X2 = 2.954; p = 0.008). Inter-arm difference was significantly more frequently observed in hypertensives vs. normotensives (29.5% vs 22.5% X2 = 24.9; p = 0.00000). There were no differences in inter-arm difference among BMI categories. We failed to find difference in all-cause mortality between subjects with > or <10 mmHg inter-arm difference (X2 = 2.114; p = 0.145). However, significantly more CV death occurred in those with inter-arm difference > 10 mmHg (73.8% vs 53.4% X2 = 3.833;p = 0.05). There were more CV deaths in uncontrolled patients with inter-arm difference >10 mmHg vs. controlled hypertensives patients with inter-arm difference >10 mmHg (77% vs 52%; X2 = 4.773; p = 0.028) Conclusions: Inter-arm BP difference was found in large number of general population. It was associated with higher CV mortality particularly in uncontrolled hypertensives. Inter-arm BP difference should be considered as a prognostic CV risk factor.