Ethnic Disparity in Inter-Arm Systolic Blood Pressure Difference and its Determinants among Asians with Type 2 Diabetes: A Cross-Sectional Study
Keywords:
type 2 diabetes, cardiovascular disease, inter-arm difference in systolic blood pressureAbstract
*Visual Abstracts prepared by Dr. Princess Landicho-Kanapi
Objectives. An inter-arm difference in systolic blood pressure (IADSBP) of 10 mmHg or more has been associated with cardiovascular disease (CVD) and increased mortality in T2DM patients. We aim to study ethnic disparity in IADSBP and its determinants in a multi-ethnic T2DM Asian cohort.
Methodology. Bilateral blood pressures were collected sequentially in Chinese (n=654), Malays (n=266) and Indians (n=313). IADSBP was analyzed as categories (<10 and ≥10 mmHg). Logistic regression model was used to evaluate the determinants of IADSBP ≥10 mmHg.
Results. Malays (27.4%) and Indians (22.4%) had higher prevalence of IADSBP ≥10 mmHg than Chinese (17.4%) (p=0.002). After adjustment for age, gender, duration of diabetes, hemoglobin A1c, body mass index (BMI), heart rate, pulse wave velocity (PWV), estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), smoking, hypertension, soluble receptor for advanced glycation end products (sRAGE), and usage of hypertension medications, ethnicity remained associated with IADSBP. While Malays were more likely to have IADSBP ≥10 mmHg than Chinese (OR=1.648, 95%CI: 1.138-2.400, p=0.009), Indians had comparable odds with the Chinese. BMI (OR=1.054, 95%CI: 1.022-1.087, p=0.001) and hypertension (OR=2.529, 95%CI: 1.811-3.533, p<0.001) were also associated with IADSBP ≥10 mmHg.
Conclusion. IADSBP in Malays were more likely to be ≥10 mmHg than the Chinese which may explain their higher risk for CVD and mortality. Measuring bilateral blood pressures may identify high-risk T2DM individuals for intensive risk factor-management.
Downloads
References
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diab Res Clin Pract. 2010;87(1):4-14.https://doi.org/10.1016/j.diabres.2009.10.007.
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes.2012;3(6):110-7.
Phan TP, Alkema L, Tai ES, Tan KHX, Yang Q, Lim WY, et al. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Res Care. 2014;2(1):e000012. https://doi.org/10.1136/bmjdrc-2013-000012.
Jha AK, Varosy PD, Kanaya AM, et al. Differences in medical care and disease outcomes among black and white women with heart disease. Circulation. 2003;108(9):1089-94. https://doi.org/10.1161/CIR.0000085994.38132.E5.
Keil JE, Sutherland SE, Knapp RG, Lackland DT, Gazes PC, Tyroler HA. Mortality rates and risk factors for coronary disease in black as compared with white men and women. The New England Journal of Medicine. 1993;329(2):73-8. https://doi.org/ 10.1056/NEJM199307083290201.
Yeo KK, Tai BC, Heng D, Lee J, Hughes K, Chew SK, et al. Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore. Diabetologia. 2006;49(12):2866-73. https://doi.org/10./s00125-006-0469-z.
Hong CY, Chia KS, Hughes K, Ling SL. Ethnic differences among Chinese, Malay and Indian patients with type 2 diabetes mellitus in Singapore. Singapore Med J. 2004;45(4):154-60. PMID: 15094983.
Dalan R, Jong M, Choo R, Chew DE, Leow MKS. Predictors of cardiovascular complication in patients with diabetes mellitus: A 5-year follow-up study in a multiethnic population of Singapore:CREDENCE II study. Int J Cardiol. 2013;169(4):e67-9. https://doi.org/10.1016/j.ijcard.2013.08.128.
Ma S, Cutter J, Tan CE, Chew SK, Tai ES. Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: Data from the 1992 Singapore National Health Survey. Am J Epidemiol. 2003;158(6):543-52. https://doi.org/10.1093/aje/kwg199
Liu J, Lim S, Yeoh L, et al. Long term follow-up of cardiovascular outcome in multiethnic Asians with type 2 diabetes mellitus (abstract). Singapore Med J. 2014;55(Suppl 1):s29.
Low S, Chi LS, Yeoh LY, Liu JJ, Fun S, Su C, et al. Long-term diabetes outcomes in multi-ethnic Asians living in Singapore. Diab Res Clin Pract. 2016;111:83-92. https://doi.org/10.1016/j.diabres.2015.09.019.
Zhang X, Liu JJ, Sum CF, Ying YL, Tavintharan S, Ng XW, et al. Ethnic disparity in central arterial stiffness and its determinants among Asians with type 2 diabetes. Atherosclerosis. 2015;242(1):22-8. https://doi.org/10.1016/j.atherosclerosis.2015.06.019.
Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34. London, UK: Royal College of Physicians, 2011. PMID: 22855971.
Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: A systematic review and metaanalysis. Lancet. 2012;379(9819):905-14. https://doi.org/10.1016/S0140-6736(11)61710-8.
Clark CE, Aboyans V. Interarm blood pressure difference: More than an epiphenomenon. Nephrol, Dial Transplant. 2015;30(5):695-7. https://doi.org/ 10.1093/ndt/gfv075.
Kleefstra N, Houweling ST, Meyboom-de Jong B, Bilo HJ. [Measuring the blood pressure in both arms is of little use; longitudinal study into blood pressure differences between both arms and its reproducibility in patients with diabetes mellitus type 2]. Ned Tijdschr Geneedskd . 2007;151(27):1509-14. PMID: 17763810.
Clark CE, Greaves CJ, Evans PH, Dickens A, Campbell JL. Inter-arm blood pressure difference in type 2 diabetes: A barrier to effective management? Br J Gen Pract. 2009;59(563):428-32. https://doi.org/3399/bjgp09X420752.
Clark CE, Steele AM, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Interarm blood pressure difference in people with diabetes: Measurement and vascular and mortality implications. Diabetes Care. 2014;37(6):1613-20. https://doi.org/10.2337/dc13-1576.
Sheng CS, Liu M, Zeng WF, Huang QF, Li Y, Wang JG. Four-limb blood pressure as predictors of mortality in elderly Chinese. Hypertension. 2013;61(6):1155-60. https://doi.org/10.1161/HYPERTENSIONAHA.111.00969.
Tokitsu T, Yamamoto E, Hirata Y, Fujisue K, Sugamura K, Maeda H, et al. Relationship between inter-arm blood pressure differences and future cardiovascular events in coronary artery disease. J Hypertens. 2015;33(9):1780-9. https://doi.org/10.1097/HJH.0000000000000616.
Su HM, Lin TH, Hsu PC, Chu CY, Lee WH, Chen SC, et al. Association of interarm systolic blood pressure difference with atherosclerosis and left ventricular hypertrophy. PloS One.2012;7(8):e41173. https://doi.org/10.1371/journal.pone.0041173.
Lane D, Beevers M, Barnes N, Bourne J, John A, Malins S, et al. Interarm differences in blood pressure: When are they clinically significant? J Hypertens. 2002;20(6):1089-95. PMID: 12023677.
White J, Mortensen LH, Kivimaki M, Gale CR, Batty GD. Interarm differences in systolic blood pressure and mortality among US army veterans: Aetiological associations and risk prediction in the Vietnam Experience Study. Eur J Prev Cardiol. 2014;21(11):1394-1400. https://doi.org/10.1177/2047487313496193.
Aboyans V, Kamineni A, Allison MA, McDermott MM, Crouse JR, Ni H, et al. The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2010;211(1):266-70. https://doi.org/10.1016/j.atherosclerosis.2010.01.013.
Liu JJ, Tavintharan S, Yeoh LY, Sum CF, Ng XW, Pek SLT, et al. High normal albuminuria is independently associated with aortic stiffness in patients with type 2 diabetes. Diabetic Med. 2014;31(10):1199-1204. https://doi.org/10.1111/dme.12461.
Rognant N, Lemoine S, Laville M, Hadj-Aissa A, Dubourg L. Performance of the chronic kidney disease epidemiology collaboration equation to estimate glomerular filtration rate in diabetic patients. Diabetes Care. 2011;34(6):1320-2. https://doi.org/2337/dc11-0203.
Johansen NB, Charles M, Vistisen D, Rasmissen S, Wiinberg N, Borch-Johnsen K, et al. Effect of intensive multifactorial treatment compared with routine care on aortic stiffness and central blood pressure among individuals with screen-detected type 2 diabetes. Diabetes care. 2012;35(11):2207-14. https://doi.org/10.2337/dc12-0176.
Pickering TG. What will replace the mercury sphygmomanometer? Blood Press Monit. 2003;8(1):23-5. https://doi.org/ 10.1097/01.mbp.89704.15. PMID: 12604932.
Hosmer DW, Lemeshow S. Applied logistic regression. New York:John Wiley & Sons, Inc., 2000. https://doi.org/ 10.1002/ 0471722146.
Kimura A, Hashimoto J, Watabe D, Takahashi H, Ohkubo T, Kikuya M, et al. Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in
Ohasama, Japan. J Hypertens. 2004;22(12):2277-83. PMID: 15614021. Geroldi D, Falcone C, Emanuele E, D'Angelo A, Calcagnino M, Buzzi MP, et al. Decreased plasma levels of soluble receptor for advanced glycation end-products in patients with essential hypertension. J Hypertens. 2005;23(9):1725-9. PMID: 16093918.
Canepa M, Milaneschi Y, Ameri P, AlGhatrif M, Leoncini G, Spallarossa P, et al. Relationship between inter-arm difference in systolic blood pressure and arterial stiffness in community-dwelling older adults. Journal of Clinical Hypertension. 2013;15(12):880-7.https://doi.org/10.1111/jch.12178.
Report of Inter-Society Commission for Heart Disease Resources. III. Cardiovascular Disease--long-term care. Guidelines for the detection, diagnosis and management of hypertensive populations. Circulation. 1971;44(Suppl 5):A263-72. PMID: 5000456.Thurston RC, Matthews KA. Racial and socioeconomic disparities in arterial stiffness and intima media thickness among adolescents. Social Sci Med. 2009;68(5):807-13. https://doi.org/10.1016/j.socscimed.2008.12.029.
Chirinos JA, Kips JG, Roman MJ, Medina-Lezama J, Li Y, Woodiwiss AJ, et al. Ethnic differences in arterial wave reflections and normative equations for augmentation index. Hypertension. 2011;57(6):1108-16. https://doi.org/10.1161/HYPERTENSIONAHA.110.166348.
GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. https://doi.org/10.1016/S0140-6736(14)61682-2.
Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143-1211. https://doi.org/10.1002/cphy.c110025.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
