Interarm systolic blood pressure difference is associated with left ventricular concentricity and concentric remodeling

Objective: Interarm systolic blood pressure difference (IASD) values >15 mmHg (IASD > 15) are associated with increased cardiovascular risk, yet the underlying mechanisms remain unclear. This report evaluated whether IASD >15, assessed by different protocols [sequential or simultaneous; based on one or several blood pressure (BP) readings], was associated with adverse left ventricular (LV) remodeling. Methods: This cross-sectional study evaluated 605 individuals who underwent clinical and echocardiography evaluation and three pairs of simultaneous arm BP readings. IASD was estimated by seven distinct protocols (three simultaneous and four sequential BP measurements criteria). Results: The cohort had a mean age of 53.5 +/- 15.4 years, with 51% being women, 23% with LV hypertrophy, 14% with LV concentricity, 69% with normal geometry, 8% with concentric remodeling, 17% with eccentric hypertrophy and 6% with concentric hypertrophy. Multivariable logistic regression revealed that IASD >15 defined by simultaneous measures of the last two pairs of BP readings (IASDsim2) and sequential arm BP readings (right-left-right arm sequence; IASDseq3) were related to LV concentricity (odds ratio [95% CI] = 3.24 [1.02-10.28], P = 0.046 and 2.56 [1.09-6.00], P = 0.030, respectively) and LV concentric remodeling (odds ratio [95% CI] = 4.12 [1.08-15.78], P = 0.039 and 4.16 [1.61-10.76], P = 0.003, respectively). Conversely, IASD >15 defined by any criteria showed no association with LV hypertrophy. Conclusion: Individuals with IASD >15 defined by IASDsim2 and IASDseq3 are associated with adverse LV remodeling, namely LV concentricity and LV concentric remodeling. These findings suggest that both criteria might be potentially used to preferentially assess abnormal IASD in the setting of clinical practice.