{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T04:00:39Z","timestamp":1786248039219,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Hypertension"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference\u2014Individual Participant Data Collaboration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              We analyzed 53\u2009172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm\u2009Hg systolic BP thresholds (both\n              <jats:italic>P&lt;<\/jats:italic>\n              0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Higher arm BP models better predicted cardiovascular events with Framingham and atherosclerotic cardiovascular disease risk scores (both\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and reclassified 4.6% and 3.5% of participants respectively to higher risk categories compared with lower arm BPs).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: CRD42015031227.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/hypertensionaha.121.18921","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T09:04:14Z","timestamp":1659431054000},"page":"2328-2335","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration"],"prefix":"10.1161","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7526-3038","authenticated-orcid":true,"given":"Christopher E.","family":"Clark","sequence":"first","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3833-0182","authenticated-orcid":true,"given":"Fiona C.","family":"Warren","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9135-5488","authenticated-orcid":true,"given":"Kate","family":"Boddy","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement Team, PenCLAHRC, University of Exeter Medical School, South Cloisters, Exeter, Devon, England (K.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0283-3095","authenticated-orcid":true,"given":"Sin\u00e9ad T.J.","family":"McDonagh","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9815-5665","authenticated-orcid":true,"given":"Sarah F.","family":"Moore","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Teresa Alzamora","sequence":"additional","affiliation":[{"name":"Unitat de Suport a la Recerca Metropolitana Nord, Fundaci\u00f3 Institut Universitari per a la recerca a l\u2019Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol), Matar\u00f3, Spain (M.T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7970-5537","authenticated-orcid":true,"given":"Rafel","family":"Ramos Blanes","sequence":"additional","affiliation":[{"name":"Unitat de Suport a la Recerca Girona. Fundaci\u00f3 Institut Universitari per a la recerca a l\u2019Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d\u2019Investigaci\u00f3 Biom\u00e8dica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-4771","authenticated-orcid":true,"given":"Shao-Yuan","family":"Chuang","sequence":"additional","affiliation":[{"name":"Institute of Population Health Sciences, National Health Research Institutes (NHRI), Zhunan, Taiwan, ROC (S.-Y.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0425-9661","authenticated-orcid":true,"given":"Michael H.","family":"Criqui","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA (M.H.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3814-1709","authenticated-orcid":true,"given":"Marie","family":"Dahl","sequence":"additional","affiliation":[{"name":"Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University (M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-9152","authenticated-orcid":true,"given":"Gunnar","family":"Engstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Science in Malm\u00f6, Lund University, Sweden (G.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimund","family":"Erbel","sequence":"additional","affiliation":[{"name":"Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany (R.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Espeland","sequence":"additional","affiliation":[{"name":"Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, NC (M.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6273-1613","authenticated-orcid":true,"given":"Luigi","family":"Ferrucci","sequence":"additional","affiliation":[{"name":"National Institute on Aging, Baltimore, MD (L.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma\u00eblenn","family":"Guerchet","sequence":"additional","affiliation":[{"name":"INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Facult\u00e9 de M\u00e9decine de l\u2019Universit\u00e9 de Limoges - 2 rue du Dr Marcland - 87 025 Limoges Cedex, France (M.G., V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-473X","authenticated-orcid":true,"given":"Andrew","family":"Hattersley","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Science, University of Exeter Medical School, RILD, Exeter, Devon, England (A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Lahoz","sequence":"additional","affiliation":[{"name":"L\u00edpid and Vascular Risk Unit. Internal Medicine Service, Carlos III - La Paz Hospital, Madrid, Spain (C.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn L.","family":"McClelland","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Washington (R.L.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-7619","authenticated-orcid":true,"given":"Mary M.","family":"McDermott","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackie","family":"Price","sequence":"additional","affiliation":[{"name":"Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henri E.","family":"Stoffers","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands (H.E.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8511-1524","authenticated-orcid":true,"given":"Ji-Guang","family":"Wang","sequence":"additional","affiliation":[{"name":"Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5021-5227","authenticated-orcid":true,"given":"Jan","family":"Westerink","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands (J.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"White","sequence":"additional","affiliation":[{"name":"DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff (J.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2886-6538","authenticated-orcid":true,"given":"Lyne","family":"Cloutier","sequence":"additional","affiliation":[{"name":"D\u00e9partement des sciences infirmi\u00e8res, Universit\u00e9 du Qu\u00e9bec \u00e0 Trois-Rivi\u00e8res, Trois-Rivi\u00e8res, Qu\u00e9bec, Canada (L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-6011","authenticated-orcid":true,"given":"Rod S.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."},{"name":"MRC\/CSO Social and Public Health Sciences Unit &amp; Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow (R.S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela C.","family":"Shore","sequence":"additional","affiliation":[{"name":"NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter, England (A.C.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3638-028X","authenticated-orcid":true,"given":"Richard J","family":"McManus","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Aboyans","sequence":"additional","affiliation":[{"name":"INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Facult\u00e9 de M\u00e9decine de l\u2019Universit\u00e9 de Limoges - 2 rue du Dr Marcland - 87 025 Limoges Cedex, France (M.G., V.A.)."},{"name":"Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYP.0000000000000065"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.02.086"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3399\/096016407782604965"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17X690461"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61710-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15997"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016844"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437741.48606.98"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.699579"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0195-668x(03)00114-3"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab309"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1109\/TAC.1974.1100705"},{"key":"e_1_3_3_15_2","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/9781118856406","volume-title":"The basics of financial econometrics: tools, concepts, and asset management applications","author":"Fabozzi FJ","year":"2014","unstructured":"Fabozzi, FJ, Focardi, SM, Rachev, ST, Arshanapalli, BG, H\u00f6chst\u00f6tter, M. 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Hypertension in adults: diagnosis and management (NG 136). 2019. Accessed July 30 2022. https:\/\/www.nice.org.uk\/guidance\/ng136."},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2016.60"}],"container-title":["Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/HYPERTENSIONAHA.121.18921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T19:01:23Z","timestamp":1668020483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/HYPERTENSIONAHA.121.18921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":24,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1161\/HYPERTENSIONAHA.121.18921"],"URL":"https:\/\/doi.org\/10.1161\/hypertensionaha.121.18921","relation":{},"ISSN":["0194-911X","1524-4563"],"issn-type":[{"value":"0194-911X","type":"print"},{"value":"1524-4563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"2021-12-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}