Evidence map›Paper›PMID 33342236›Full record

ArticleHypertension (Dallas, Tex. : 1979)2021

Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration.

Christopher E Clark, Fiona C Warren, Kate Boddy, Sinead T J McDonagh, Sarah F Moore, John Goddard, Nigel Reed, Malcolm Turner, Maria Teresa Alzamora, Rafel Ramos Blanes and 23 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Hypertension (Dallas, Tex. : 1979), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Review
  5. Article
  6. Review
  7. Association of mortality with longitudinal changes in right- and left-arm blood pressure discrepancies among hypertensive adults.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Article
  8. Measuring both arms: a simple step to gain valuable insights.Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Article
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  16. Acute Limb Ischemia Presenting as a Clinical Conundrum: Stroke Mimic or Aortic Dissection?European journal of case reports in internal medicine · 2025
    Article
  17. Current topic of vascular function in hypertension in 2023-2024.Hypertension research : official journal of the Japanese Society of Hypertension · 2024
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

33 authors.

Christopher E ClarkFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Fiona C WarrenFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Kate BoddyPatient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Sinead T J McDonaghFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Sarah F MooreFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
John GoddardPatient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Nigel ReedPatient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Malcolm TurnerPatient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Maria Teresa AlzamoraUnitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.).
Rafel Ramos BlanesUnitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d'Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.).
Shao-Yuan ChuangInstitute of Population Health Sciences, National Health Research Institutes (NHRI), Taiwan, R.O.C (S.-Y.C.).
Michael CriquiDepartment of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (M.C.).
Marie DahlVascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark (M.D.).
Gunnar EngströmDepartment of Clinical Science in Malmö, Lund University, Sweden (G.E.).
Raimund ErbelInstitute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany (R.E.).
Mark EspelandWake Forest School of Medicine, NC (M.E.).
Luigi FerrucciNational Institute on Aging, Baltimore MD (L.F.).
Maëlenn GuerchetINSERM U1094 & IRD, Tropical Neuroepidemiology, Institut d'Epidémiologie et de Neurologie Tropicale (IENT), Faculté de Médecine de l'Université de Limoges, Limoges Cedex, France (M.G., V.A.).
Andrew HattersleyInstitute of Biomedical and Clinical Science (A.H.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Carlos LahozLípid and Vascular Risk Unit, Internal Medicine Service, Carlos III, La Paz Hospital, Madrid, Spain (C.L.).
Robyn L McClellandDepartment of Biostatistics, University of Washington, WA (R.L.M.).
Mary M McDermottNorthwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.).
Jackie PriceUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.).
Henri E StoffersDepartment of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands (H.E.S.).
Ji-Guang WangCentre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.).
Jan WesterinkDepartment of Vascular Medicine, University Medical Center Utrecht, the Netherlands (J. Westerink).
James WhiteDECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Wales (J. White).
Lyne CloutierDépartement des Sciences Infirmières, Université du Québec à Trois-Rivières, Canada (L.C.).
Rod S TaylorFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.
Angela C ShoreNIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter College of Medicine & Health, England (A.C.S.).
Richard J McManusNuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.).
Victor AboyansDepartment of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.).
John L CampbellFrom the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.

Funding

Biomarkers of Homestatic Dysregulation in Aging and Chronic DiseaseZIAAG000971 · NIA · NATIONAL INSTITUTE ON AGING · PI FERRUCCI, LUIGI · 2009 to 2025
$1.9M
Department of Health NIHR-RP-02-12-015Department of Health PB-PG-0215-36009
6 · The paper itself

Abstract

Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.

Indexed as

AdolescentAdultAgedAged, 80 and overAlgorithmsBlood PressureBlood Pressure DeterminationCardiovascular DiseasesFemaleHumansMaleMiddle AgedPrognosisSurvival RateSystoleYoung Adultblood pressurecardiovascular diseasemeta-analysismortalityrisk

Identifiers

PMID33342236
PMCPMC7803446

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.