Ankle and exercise blood pressures as predictors of coronary morbidity and mortality in a prospective follow-up study

Abstract

Elevated ankle blood pressure (ABP) may be one of the earliest signs of subclinical atherosclerosis. However, its behavior in different degrees of atherosclerotic vascular damage has not been well characterized. We examined the association of ABP and brachial exercise blood pressure with the incidence of future coronary events. A cohort of 3808 consecutive ambulatory persons (mean age 50 years, 34% women), referred to a symptom-limited exercise test and free of cardiovascular events at baseline, was prospectively followed up for 15 years. Altogether, 383 (80 fatal and 303 non-fatal) incident coronary events occurred. Cox proportional hazards models, adjusting for several conventional risk factors, were used to analyse the independent association of ABP with the risk of an incident coronary heart disease (CHD) event. Persons with normal ankle, brachial resting and brachial exercise blood pressures were taken as the reference group. Other groups were formed on the basis of ankle and exercise blood pressures and compared with the reference group. Even in persons among whom the elevated ABP was the only abnormal finding, the multivariate adjusted hazard ratio (HR) of a future CHD event was significantly elevated (HR ¼ 1.60, 95% confidence interval 1.20-2.14, Po0.0001). In general, the HRs were higher for fatal events than for non-fatal events. The measurement of ABP could be an inexpensive and non-invasive tool to detect elevated risk of a CHD event.

Ankle Blood Pressure and Pulse Pressure as Predictors of Cerebrovascular Morbidity and Mortality in a Prospective Follow-Up Study

“…The methods of baseline data collection have been described in our previous paper [1]. The subjects were derived from a group of 4,038 consecutive ambulatory patients who underwent a symptom-limited bicycle exercise test at the Deaconess Institute between August 1989 and December 1995.…”

“…High ankle blood pressure (ABP) might be an emerging risk marker for early subclinical damage of arterial vessels evaluated as elevated ankle blood pressure alone [1, 2] or in conjunction with the elevated ankle brachial index (ABI) [3–5]. The high ABP or high ABI provides an indication of arterial stiffness or atherosclerosis of the vessel wall whereas the low ankle pressure or low ABI is indicative of advanced atherosclerosis, which has reached the point where the blood flow is impeded.…”

The Prevalence and Influence Factors of Inter-Ankle Systolic Blood Pressure Difference in Community Population

“…A study showed that the leg BP in orthostatic posture is associated with left ventricular mass in normotensive subjects [9]. Furthermore, increased ankle BP is a marker of arterial stiffness or subclinical atherosclerosis, and an independent risk for future dementia, cardio-cerebrovascular morbidity and mortality [10],[11].…”

Ankle pressures in UK South Asians with diabetes mellitus: a case control study

“…Peripheral arterial pressures often differ between the posterior tibial (PT) and the dorsalis pedis (DP) and between the right and left leg 6. In Europeans, absolute ankle pressures correlate better with peripheral arterial disease than ABI and elevated pressure was identified as an independent predictor of incident coronary heart disease 7 8…”