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 pressure
Abstract*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.
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