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    Inter-arm difference in systolic blood pressure in different ethnic groups and relationship to the “white coat effect”: a cross sectional study

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    Mohammed_American_Journal_of_Hypertension.pdf (212.9Kb)
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    Publication date
    2017-09
    Author
    Schwartz, C.L.
    Clark, C.E.
    Koshiaris, C.
    Gill, P.S.
    Greenfield, S.M.
    Haque, M.S.
    Heer, G.
    Johal, A.
    Kaur, R.
    Mant, J.
    Martin, U.
    Mohammed, Mohammed A.
    Wood, S.
    McManus, R.J.
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    Keyword
    Interarm blood pressure differences; Ethnic group; Simultaneous blood pressure measurement method; White coat effect; Ambulatory blood pressure monitoring
    Rights
    ©The Author 2017. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
    Peer-Reviewed
    Yes
    
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    Abstract
    Background: Inter-arm differences (IAD) ≥10mmHg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic inter-arm differences (ssIADs) are not well understood. Methods: Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using two BP-Tru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory monitoring (ABPM). WCE was defined as systolic Clinic BP ≥10mmHg higher than daytime ABPM. Results: No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%) and 2nd-6th (78, 11%) (1st vs 2nd/3rd and 2nd-6th, p<0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (OR 1.73 (95% CI 1.04-2.86), 2nd/3rd, (OR 3.05 (1.68-5.53) and 2nd-6th measurements, (OR 2.58 (1.22-5.44). Non-hypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 -8.25) only. Conclusion: ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs.
    URI
    http://hdl.handle.net/10454/11880
    Version
    Published version
    Citation
    Schwartz CL, Clark CE, Koshiaris C et al (2017) Inter-arm difference in systolic blood pressure in different ethnic groups and relationship to the “white coat effect”: a cross sectional study. American Journal of Hypertension. 30(9): 884-891.
    Link to publisher’s version
    https://doi.org/10.1093/ajh/hpx073
    Type
    Article
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    Health Studies Publications

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