Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 15;16(10):e0257443.
doi: 10.1371/journal.pone.0257443. eCollection 2021.

Association between inter-leg blood pressure difference and cardiovascular outcome in patients undergoing percutaneous coronary intervention

Inki Moon  1 , Hack-Lyoung Kim  2 , Woo-Hyun Lim  2 , Jae-Bin Seo  2 , Joo-Hee Zo  2 , Myung-A Kim  2 , Sang-Hyun Kim  2
Affiliations

Association between inter-leg blood pressure difference and cardiovascular outcome in patients undergoing percutaneous coronary intervention

Inki Moon et al. PLoS One. .

Abstract

Background: Although the inter-arm blood pressure (BP) difference has been advocated to be associated with cardiovascular events, the implication of inter-leg BP difference has not been well established. This study was conducted to investigate whether inter-arm and -leg BP differences have prognostic value in patients undergoing percutaneous coronary intervention (PCI).

Methods: In this prospective study, we consecutively enrolled 667 patients who underwent PCI. Both arm and leg BPs were measured at the day after PCI. The primary outcome was a major adverse cardiovascular event (MACE) including cardiac death, acute coronary syndrome, coronary revascularization, stroke, and hospitalization for heart failure during the follow-up period.

Results: Mean age was 64.0±11.1 years old, and males were predominant (70.5%). During a mean follow-up period of 3.0 years, MACE occurred in 209 (31.3%) patients. The inter-leg systolic BP difference (ILSBPD) was significantly higher in patients with MACE than those without (9.9±12.3 vs. 7.2±7.5 mmHg, P = 0.004). The inter-arm systolic BP difference was not significantly different between patients with and without MACE (P = 0.403). In multivariable Cox regression analysis, increased ILSBPD was independently associated with the development of MACE (per 5 mmHg; hazard ratio, 1.07; 95% confidence interval, 1.01-1.14). The inter-arm systolic BP difference was not associated with MACE in the multivariable analysis.

Conclusion: Increased ILSBPD was independently associated with worse cardiovascular outcomes after PCI. As ILSBPD is easy to measure, it may be helpful in the risk stratification of patients undergoing PCI.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier curves for MACE and risk of MACE according to ILSBPD.
The curves for survival from MACE are presented according to ILSBPD (<16 vs. ≥16 mmHg). Abbreviation: HR, hazard ratios; ILSBPD, inter-leg systolic blood pressure difference; MACE, major adverse cardiovascular events.
Fig 2
Fig 2. Additional prognostic value of ILSBPD in MACE.
The additional prognostic value of ILSBPD is presented in the prediction models with age, sex, and clinical factors. (A) the prognostic value of ILSBPD for categorical variables (<16 vs. ≥16 mmHg). (B) the prognostic value of ILSBPD for continuous variables. The clinical factors included hypertension, diabetes mellitus, coronary artery disease, atrial fibrillation, chronic kidney disease, previous stroke, current smoker, and hemoglobin. Abbreviation: ILSBPD, inter-leg systolic blood pressure difference; MACE, major adverse cardiovascular events.
See this image and copyright information in PMC

References

    1. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018;392(10159):1736–88. doi: 10.1016/s0140-6736(18)32203-7 - DOI - PMC - PubMed
    1. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47. Epub 1998/05/29. doi: 10.1161/01.cir.97.18.1837 . - DOI - PubMed
    1. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Journal of the American College of Cardiology. 2014;63(25):2935–59. doi: 10.1016/j.jacc.2013.11.005 - DOI - PMC - PubMed
    1. Lloyd-Jones DM. Cardiovascular risk prediction: basic concepts, current status, and future directions. Circulation. 2010;121(15):1768–77. Epub 2010/04/21. doi: 10.1161/CIRCULATIONAHA.109.849166 . - DOI - PubMed
    1. Clark CE, Campbell JL, Evans PH, Millward A. Prevalence and clinical implications of the inter-arm blood pressure difference: A systematic review. J Hum Hypertens. 2006;20(12):923–31. Epub 2006/10/13. doi: 10.1038/sj.jhh.1002093 . - DOI - PubMed