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Vol. 32. Issue 3.
Pages 94-100 (May - June 2020)
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Vol. 32. Issue 3.
Pages 94-100 (May - June 2020)
Original article
Association between an elevated inter-arm systolic blood pressure difference, the ankle–brachial index, and mortality in patients with diabetes mellitus
Asociación entre una diferencia elevada de presión arterial sistólica entre brazos, el índice tobillo-brazo y la mortalidad en pacientes con diabetes mellitus
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Javier Enaa,?
Corresponding author
ena_jav@gva.es

Corresponding author.
, Santiago Pérez-Martína, Carlos R. Argenteb, Teresa Lozanoc
a Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
b Sección de Endocrinología y Nutrición, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
c Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain
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Tables (3)
Table 1. Patients characteristics.
Table 2. Systolic blood pressure values in the study population.
Table 3. Inter-arm systolic blood pressure difference values according to the ABI strata.
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Abstract
Objectives

To estimate the prevalence of an inter-arm blood pressure difference greater than 10mmHg in patients with type 2 diabetes, and the association of this measurement with the presence of a low ankle–brachial index and mortality at 5-year follow-up.

Method

A validated blood pressure measurement protocol was used. The blood pressure was calculated for each arm to obtain mean systolic differences. Peripheral arterial disease was confirmed by an ankle–arm index less than 0.9. The medical history of the patient was reviewed in the computerized clinical notes after 5 years of follow-up.

Results

The study included 139 patients with a mean age of 70.1 years (49% male), and a mean duration of diabetes mellitus of 10.8 years. A total of 50 (36%) patients had an inter-arm systolic blood pressure difference greater than 10mmHg. Patients with an inter-arm systolic blood pressure greater than 10mmHg had lower ankle–arm index (0.91±0.30 vs. 1.04±0.28, P=0.005), and higher mortality rates from all causes (48.0% vs. 28.9%; hazard ratio 1.64; 95% confidence interval: 1.06–2.53; P=0.03), compared with those with lower inter-arm systolic blood pressure difference.

Conclusion

A high proportion of patients with type 2 diabetes have an elevated systolic blood pressure difference between arms. A significant relationship was found between elevated inter-arm systolic blood pressure difference, lower ankle–brachial index and greater all-cause mortality.

Keywords:
Blood pressure measurement
Diabetes mellitus
Peripheral arterial disease
Mortality
Resumen
Objetivos

Estimar la prevalencia de una diferencia de presión arterial entre brazos superior a 10mmHg en pacientes con diabetes tipo 2, y su asociación con el índice tobillo-brazo y la mortalidad a los 5 años de seguimiento.

Método

Se utilizó un protocolo validado de medición de presión arterial. La presión sanguínea se calculó para cada brazo para obtener diferencias sistólicas medias. La enfermedad arterial periférica fue confirmada por un índice tobillo-brazo inferior a 0,9. El estado vital del paciente se revisó en la historia clínica electrónica a los 5 años de seguimiento.

Resultados

Estudiamos a 139 pacientes con una edad media de 70,1 años (49% hombres) y una duración media de diabetes mellitus de 10,8 años. Un total de 50 (36%) pacientes tenía una diferencia de presión arterial sistólica entre brazos mayor de 10mmHg. Los pacientes con diferencia elevada de presión arterial sistólica entre los brazos mostraron un menor índice tobillo-brazo (0,91±0,30 vs. 1,04±0,28; P=0,005), y una mayor tasa de mortalidad por todas las causas (48,0% vs. 28,9%; cociente de riesgo 1,64; intervalo de confianza al 95%: 1,06-2,53; P=0,03), respecto a los pacientes con menores diferencias de presión sistólica entre brazos.

Conclusión

Encontramos una alta proporción de pacientes con diabetes tipo 2 que tenían una diferencia elevada de presión arterial sistólica entre los brazos. Existe una asociación significativa entre la diferencia elevada de la presión arterial sistólica entre brazos, el índice tobillo-brazo y mortalidad.

Palabras clave:
Presión arterial
Diabetes mellitus
Enfermedad arterial periférica
Mortalidad

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