A Comparative Analysis of the Inter-Arm Blood Pressure of Post-Stroke Patients with Left Hemiparesis and Healthy Subjects
DOI:
https://doi.org/10.64229/5nez6825Keywords:
Inter-arm blood pressure difference, Stroke, Hemiparesis, Hypertension, Vascular asymmetryAbstract
Background: Inter-arm blood pressure difference (IABPD) is a marker of vascular asymmetry and cardiovascular risk. In post-stroke patients with hemiparesis, altered vascular regulation may heighten IABPD, yet its clinical significance remains underexplored. Aim: To compare IABPD between post-stroke patients with left hemiparesis and healthy controls, and to assess its relevance in hypertension management. Materials and Methods: A comparative cross-sectional study was conducted among 150 post-stroke patients and 150 age- and sex-matched controls. Simultaneous bilateral blood pressure readings were obtained under standardized conditions using a validated digital sphygmomanometer. Pulse pressure (PP) was calculated as systolic minus diastolic blood pressure. Data were analyzed using descriptive statistics and independent t-tests (p < 0.05). Results: Stroke patients showed significantly higher mean systolic IABPD (9.1 ± 6.8 mmHg) than controls (0.7 ± 3.2 mmHg; p < 0.0001), and higher diastolic IABPD (3.5 ± 5.1 mmHg vs. 0.4 ± 2.7 mmHg; p < 0.0001). Pulse pressure was also elevated, indicating increased arterial stiffness. The greatest IABPD occurred within three months post-stroke and declined gradually but persisted beyond six months. Conclusion: Markedly higher IABPD in stroke survivors underscores the need for routine bilateral blood pressure measurement to identify the dominant arm for monitoring and treatment. This simple, low-cost approach may enhance hypertension detection and reduce recurrent stroke risk, especially in resource-limited settings.
References
[1]World Health Organization. Stroke: Key facts. 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/stroke. (accessed on January 2026).
[2]Tan SML, Ong SH, Yeo TT, Nga VDW, Chew E, Tam PK, et al. Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke. Clinical Neurology and Neurosurgery, 2023, 233, 107964. DOI: 10.1016/j.clineuro.2023.107964
[3]Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): Global stroke fact sheet 2022. International Journal of Stroke, 2022, 17(1), 18-29. DOI: 10.1177/17474930211065917
[4]Abissegue G, Yakubu SI, Ajay AS, Niyi-Odumosu F. A systematic review of the epidemiology and the public health implications of stroke in Sub-Saharan Africa. Journal of Stroke and Cerebrovascular Diseases, 2024, 33(8), 107733. DOI: 10.1016/j.jstrokecerebrovasdis.2024.107733
[5]Ogbutor UG, Nwangwa EK, Agbonifo CE, Nwabueze Z, Ephraim C, Nwogueze BC, et al. Acute blood pressure and pulse rate response to isometric handgrip exercise at 30% maximum voluntary contraction in prehypertensive subjects. Advances in Applied Physiology, 2022, 7(1), 8-14. DOI: 10.11648/j.aap.20220701.12
[6]Akinyemi RO, Ovbiagele B, Adeniji OA, Sarfo FS, Abd-Allah F, Adoukonou T, et al. Stroke in Africa: Profile, progress, prospects and priorities. Nature Reviews Neurology, 2021, 17(10), 634-656. DOI: 10.1038/s41582-021-00542-4
[7]Pitliya A, Khatri K, Elapolu AC, Ahmed R, Kancherla N, Jonnala RR, et al. Incidence and prevalence of acute stroke and its clinical implications and outcomes in patients with sickle cell disease: A systematic review. Journal of Applied Hematology, 2023, 14(3), 177-186. DOI: 10.4103/joah.joah_48_23
[8]Ogbutor GU, Nwangwa EK, Uyagu DD. Isometric handgrip exercise training attenuates blood pressure in prehypertensive subjects at 30% maximum voluntary contraction. Nigerian Journal of Clinical Practice, 2019, 22(12), 1765-1771. 10.4103/njcp.njcp_240_18
[9]Gargot J, Parriault MC, Adenis A, Clouzeau J, Dinh Van KA, Ntab B, et al. Low stroke risk in children with sickle cell disease in French Guiana: A retrospective cohort study. Frontiers in Medicine, 2022, 9, 854379. DOI: 10.3389/fmed.2022.851918
[10]Kirkham FJ, Lagunju IA. Epidemiology of stroke in sickle cell disease. Journal of Clinical Medicine, 2021, 10(18), 4232. DOI: 10.3390/jcm10184232
[11]Ogbutor UG, Nwangwa EK, Nkemakonam E, Ephraim C, Ugoeze FC, Ezunu E, et al. The blood pressure and pulse rate responses to isometric handgrip exercise and the effects of variation of duration and intensity of the exercise protocol in prehypertensive patients. Biomedical Journal of Scientific and Technical Research, 2022, 43(2), 34450-34461. DOI: 10.26717/BJSTR.2022.43.006884
[12]Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: A systematic review. Journal of Hypertension, 2017, 35(3), 421-441. DOI: 10.1097/HJH.0000000000001197
[13]Asmar R, Stergiou G, de la Sierra A, Jelaković B, Millasseau S, Topouchian J, et al. Blood pressure measurement and assessment of arterial structure and function: An expert group position paper. Hypertension, 2024, 42(9), 1465-1481. DOI: 10.1097/HJH.0000000000003787
[14]Clark CE, Warren FC, Boddy K, McDonagh STJ, Moore SF, Teresa Alzamora M, et al. Higher arm versus lower arm systolic blood pressure and cardiovascular outcomes: A meta-analysis of individual participant data from the INTERPRESS-IPD Collaboration. Hypertension, 2022, 79(11), 2328-2335. DOI: 10.1161/HYPERTENSIONAHA.121.18921
[15]Aboyans V, Criqui MH, McDermott MM, Allison MA, Denenberg JO, Shadman R, et al. The vital prognosis of subclavian stenosis. Journal of the American College of Cardiology, 2007, 49(14), 1540-1545. DOI: 10.1016/j.jacc.2006.09.055
[16]Peng HP, Tao L, Tang M, Su H. Inter-arm blood pressure difference in post-stroke patients with hemiparesis. Journal of Human Hypertension, 2024, 38(3), 228-231. DOI: 10.1038/s41371-023-00886-y
[17]Das S, Iktidar MA, Das J, Chowdhury F, Roy S. Inter-arm blood pressure difference as a tool for predicting coronary artery disease severity. Open Heart, 2022, 9(2), e002063. DOI: 10.1136/openhrt-2021-002063
[18]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 meta-analysis. Lancet, 2012, 379(9819), 905-914. DOI: 10.1016/S0140-6736(11)61710-8
[19]Charan J, Biswas T. How to calculate sample size for different study designs in medical research. Indian Journal of Psychological Medicine, 2013, 35(2), 121-126. DOI: 10.4103/0253-7176.116232
[20]Matanes F, Siddiqui M, Velasco A, Sharifov O, Kreps E, Dudenbostel T, et al. Adverse cardiac remodeling is absent in patients with true controlled resistant hypertension. Journal of Clinical Hypertension, 2023, 25(5), 457-465. DOI: 10.1111/jch.14625
[21]Yin MZ, Kim HJ, Suh EY, Zhang YH, Yoo HY, Kim SJ. Endurance exercise training restores atrophy-induced decreases of myogenic response and ionic currents in rat skeletal muscle artery. Journal of Applied Physiology, 2019, 126(6), 1713-1724. DOI: 10.1152/japplphysiol.00790.2018
[22]Jung Y, Kim J, Jang H, Kim G, Kwon YW. Strategy of patient-specific therapeutics in cardiovascular disease through single-cell RNA sequencing. Korean Circulation Journal, 2023, 53(1), 1-16. DOI: 10.4070/kcj.2022.0295
[23]Högg S, Holzgraefe M, Drüge C, Hauschild F, Herrmann C, Obermann M, et al. High-intensity arm resistance training does not lead to better outcomes than low-intensity resistance training in patients after subacute stroke: A randomized controlled trial. Journal of Rehabilitation Medicine, 2020, 52(5), jrm00067. DOI: 10.2340/16501977-2686
[24]Kuikel S, Rauniyar R, Kharel S, Bist A, Giri S, Thapaliya S, et al. Prevalence of stroke in Asian patients with sickle cell anemia: A systematic review and meta-analysis. Neurology Research International, 2021, 1-7. DOI: 10.1155/2021/9961610
[25]Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2011, 42(9), 2672-713. DOI: 10.1161/STR.0b013e3182299496
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Copyright (c) 2026 Ogbutor Udoji Godsday, Atose Omorigho Greatcrown, Ogbutor Emeke Godson, Nofiu Oluwatobi Daniel, Abdulfatah Hajara Aminu, Uti Oghenerohro Mercy, Anastacia Okwudili Ojimba, Isaac Precious (Author)
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