Interarm BP Differences Predict Cardiovascular Events in CKD Patients

Regular monitoring of blood pressure may help clinicians determine which CKD patients are at increased risk of CV events.
Regular monitoring of blood pressure may help clinicians determine which CKD patients are at increased risk of CV events.

Increased interarm systolic blood pressure difference independently predicts cardiovascular (CV) events in patients with chronic kidney disease (CKD), according to a new study.

Borja Quiroga, MD, PhD, and colleagues at Hospital General Universitario Gregorio Marañón, in Madrid, Spain, prospectively studied 652 CKD patients with a mean age of 67 years. The study population had a mean follow-up period of 19 months. Of these patients, 136 (20.8%) had diabetes mellitus, 213 (32.6%) had a history of cardiovascular disease, and 327 (50.1%) had dyslipidemia. 

The interarm systolic blood pressure difference (IASBPD) was 10 mm Hg or greater in 184 patients (28.1%). The investigators noted that previous research has found a correlation between an IASBPD of 10 mm Hg or greater and CV risk factors in the general population and in patients with specific conditions such as vascular disease and diabetes mellitus.

Cardiovascular events occurred in 58 patients (8.5%). An IASBPD of 10 mm Hg or greater was associated with a significant 80% increased risk of CV events after adjusting for classical risk factors such as a history of CV disease, Dr. Quiroga's group reported online ahead of print in Nephrology Dialysis Transplantation.

“Our findings led us to hypothesize that patients with CKD can stratify their CV risk with regular monitoring of blood pressure,” the authors wrote. “In addition, patients with increased IASBPD should be considered at high risk of CV events, and probably intensive control and early treatment could improve their prognosis.”

The researchers explained that in most instances, a difference in BP between arms is due to subclinical atherosclerosis, but other possible causes include coarctation of the aorta, aortic aneurism, connective tissue disorders, vasculitis, and thoracic compression.

For the study, the investigators defined CV events as myocardial infarction, congestive heart failure and/or a left ventricular ejection fraction of less than 45%, ischemic or hemorrhagic cerebrovascular accident, peripheral vascular disease, and other ischemic conditions.

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