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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article presents results from a study of inter-arm differences (IAD) in systolic blood pressure in patients with diabetes. Simultaneous measurements, often impractical in a clinical setting, were obtained and compared with calculated sequential pairs. Associations between IAD and vascular disease and mortality were also explored.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EChristopher E. Clark, PhD, University of Exeter Medical School, Devon, United Kingdom, presented results from a study of inter-arm differences (IAD) in systolic blood pressure (BP) in patients with diabetes. Simultaneous measurements, often impractical in a clinical setting, were obtained and compared with calculated sequential pairs. Associations between IAD and vascular disease and mortality were also explored.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOnce they had provided informed consent, patients with diabetes and nondiabetic control patients underwent 4 pairs of bilateral simultaneous automated BP measurements. After 2 simultaneous measurements were conducted in a random order, cuffs were switched to the opposite arms and another pair of measurements was obtained. For the simultaneous measurements, IADs were calculated for each pair by subtracting the left BP from the right BP. Sequential pairs were modeled by subtracting the second or fourth left BP from the first right BP, for best and worst case sequential pairs. Demographic information was collected from each participant. Patient records were flagged in the National Health Service Information Centre to acquire mortality data from death certificates.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA total of 727 patients with diabetes and 285 controls were enrolled. Of these, 514 (71%) of the patients with diabetes and 238 (84%) of the controls had 4 pairs of BP results (p\u0026lt;0.001). Prof. Clark attributed the smaller number of diabetes patients with complete results to the larger number of patients with atrial fibrillation in the diabetes group.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe control group was younger and two-thirds were hypertensive versus 90% of the patients with diabetes. In the diabetes population, 8.6% had a systolic IAD \u226510 mm Hg compared with 2.9% of the controls. Prof. Clark stated that he and his colleagues could not attribute the reason for this difference in systolic IAD entirely to diabetes. Both the simultaneous and sequential single pair measurements were significant (p\u0026lt;0.001 for both) in a receiver operating characteristics curve, indicating that a sequential single pair is a useful way to determine IAD in place of simultaneous measurements.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EA systolic IAD \u226510 mm Hg was associated with peripheral artery disease (OR, 3.1; 95% CI, 1.2 to 8.0; p=0.03) and retinopathy (OR, 1.8; 95% CI, 1.0 to 3.4; p=0.056). A systolic IAD \u226515 mm Hg was associated with retinopathy (OR, 6.5; 95% CI, 1.7 to 24.4; p=0.003) and chronic kidney disease (OR, 5.4; 95% CI, 1.4 to 21.1; p=0.033). Additionally, preliminary survival data showed a significant difference in cardiovascular mortality in patients with systolic IAD \u226510 mm Hg (HR, 4.6; 95% CI, 1.2 to 17.6; p=0.028) and systolic IAD \u226515 mm Hg (HR, 10.9; 95% CI, 2.3 to 51.3; p=0.003).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProf. Clark emphasized that \u201cthere [were] relatively few [adverse] events included in this [study and that they] intend to return to this in the future when a significant number of events have been collected.\u201d He advised clinicians to measure BP in both arms when initially evaluating patients with diabetes as systolic IADs are associated with vascular disease and possibly related to increased cardiovascular mortality.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/9\/11.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznupq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}