Ethnic Disparity in Inter-Arm Systolic Blood Pressure Difference and its Determinants among Asians with Type 2 Diabetes: A Cross-Sectional Study


  • Xiao Zhang Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
  • Jian Jun Liu Clinical Research Unit, Khoo Teck Puat Hospital
  • Chee Fang Sum Diabetes Centre and Department of Medicine, Khoo Teck Puat Hospital
  • Yeoh Lee Ying Department of Medicine, Khoo Teck Puat Hospital
  • Subramaniam Tavintharan Diabetes Centre and Department of Medicine, Khoo Teck Puat Hospital
  • Na Li Clinical Research Unit, Khoo Teck Puat Hospital
  • Chang Su Clinical Research Unit, Khoo Teck Puat Hospital
  • Serena Low Clinical Research Unit, Khoo Teck Puat Hospital
  • Simon BM Lee National Healthcare Group Polyclinics
  • Wern Ee Tang National Healthcare Group Polyclinics
  • Su Chi Lim Diabetes Centre and Department of Medicine, Khoo Teck Puat Hospital


type 2 diabetes, cardiovascular disease, inter-arm difference in systolic blood pressure


*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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How to Cite

Zhang, X., Liu, J. J., Sum, C. F., Ying, Y. L., Tavintharan, S., Li, N., Su, C., Low, S., Lee, S. B., Tang, W. E., & Lim, S. C. (2016). Ethnic Disparity in Inter-Arm Systolic Blood Pressure Difference and its Determinants among Asians with Type 2 Diabetes: A Cross-Sectional Study. Journal of the ASEAN Federation of Endocrine Societies, 31(2), 81. Retrieved from



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