Targeting the Association between Interarm Blood Pressure Difference and Subclinical Organ Damage: Findings from the PAMELA Study

Background: Evidence on the association of interarm difference (IAD) in BP with subclinical cardiac and vascular damage in community-based populations is scanty. We addressed this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study. Methods: The study included 527 participants who attended the third survey of the PAMELA study performed after 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, blood examinations, office BP, simultaneous IAD assessment, echocardiographic and cardio-ankle velocity index (CAVI) measurements. Results: In the whole study sample (age 66 ± 10 years, 49% males), the prevalence of systolic IAD (ie, IASD ≥ 10 mm Hg) was 12%. Although the association between IASD and left ventricular hypertrophy (LVH) (OR = 2.45, P = .007) disappeared after adjustment for several factors, this abnormal BP phenotype was twice as high in participants with LVH compared to those with normal LV geometry (21.7% vs 10.2%, P < .01). Furthermore, the prevalence of IASD in participants with LVH and LV remodeling was overall 3 times higher than in their normal counterparts. As for vascular damage, no relationship emerged between IASD with CAVI, treated either as a categorical (ie, CAVI > 9 m/second) or continuous variable. Conclusions: Our study provides a new piece of evidence on the value of IASD as a potential marker of LVH, which in turn reflects the burden of several coexisting cardiovascular risk factors. From a practical perspective, the detection of IASD could be a clinical rationale for investigating subclinical cardiac organ damage.