Increased interarm blood pressure difference is associated with autonomic dysfunction and atherosclerosis in patients with chest pain and no history of coronary artery disease.

OBJECTIVES: Interarm blood pressure (BP) difference has been reported to be associated with atherosclerosis and increased cardiovascular death. We were to investigate associations of interarm systolic blood pressure (SBP) difference with heart rate recovery (HRR) after exercise, an index of autonomic function, and carotid atherosclerotic markers, and to evaluate the association of interarm SBP difference with concurrent coronary artery disease (CAD).

METHODS: A total of 995 consecutive patients who underwent treadmill stress echocardiography with chest pain but no history of CAD were enrolled. Interarm SBP difference, carotid intima-media thickness (IMT) and plaque were measured before exercise, and HRR 2min following exercise was assessed. Suspected CAD was defined as newly developed wall motion abnormalities after treadmill exercise.

RESULTS: Patients with an interarm SBP difference≥10mmHg had higher prevalence of hypertension, increased right and left SBP, right diastolic BP, mean arterial pressure, body mass index and carotid IMT, existent carotid plaque, lower metabolic equivalents and slower HRR. Interarm SBP difference≥10mmHg was independently associated with slower HRR and existent carotid plaque. Suspected CAD was associated with existent carotid plaque or slower HRR, but not with an interarm SBP difference≥10mmHg.

CONCLUSIONS: Increased interarm SBP difference was associated with lower autonomic modulation and carotid atherosclerosis in patients with chest pain and no history of CAD, but not with suspected CAD. Observed adverse prognosis in patients with increased interarm BP difference might result from long-term persistent autonomic dysfunction and atherosclerosis.