Ankle blood pressure as a predictor of total and cardiovascular mortality

Abstract

Background: The ankle blood pressure is commonly used as a ratio to the brachial blood pressure, called ankle-brachial index (ABI). Very few studies have considered the independent value of the ankle blood pressure without indexing it to the brachial blood pressure. We examined the value of ankle blood pressure, together with the exercise blood pressure, as a predictor of cardiovascular (CVD) and total mortality.

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

“…It is postulated that raised ankle pressures due to arterial stiffness precede occlusive vascular disease in the lower limbs 20. Medial calcification in DM in Europeans is associated with fourfold increased risk of lower extremity amputation and twofold cardiovascular mortality 21 22.…”

“…There are no accepted normal reference ranges for ankle pressures in South Asians and so potential associations were studied using ankle pressure as a continuous variable to increase the power of the study. In 1991, calcification of the lower-extremity arteries was considered if ankle pressure was more than 100 mm Hg higher than brachial pressure23 but now an ankle pressures of >175 mm Hg is considered to be a marker 20. Ankle pressures in South Asians with DM are higher than those without but were similar to those in older Europeans with DM and could be because the DM is diagnosed at a younger age and high blood glucose predisposes South Asians to medial artery stiffness and calcification earlier or to a greater extent than it does occlusive disease in lower limbs potentially due to different haemodynamics or wave reflection 24.…”

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

“…In our earlier study, we have shown that the same categories of ankle and exercise brachial blood pressure predicted total and cardiovascular mortality. 12 The novel features of this study were the specific focus on CHD, including both morbidity and mortality, and the addition of two more years of follow-up time. This study extended the earlier observations by showing that the differences in mortality between the blood pressure groups were largely due to CHD.…”

“…12 More advanced atherosclerosis is propagated from the arterial wall to the arterial lumen and stenotic changes along the conduit vessels decrease the ABP. This step is reached when physical exercise causes an exaggerated blood pressure reaction while the ABP is normal.…”

Clinical and prognostic features in asymptomatic and symptomatic patients with arteriosclerosis obliterans

“…Epidemiological studies in the general population have shown the incidence of ASO to be 1% in people aged below 60% and 3.4% in people aged 65 or more [5]. Furthermore, the estimated number of patients with ASO in Japan, including asymptomatic patients, ranges from 500,000 to 800,000 [6][7][8]. Patients with ASO have also been shown to have a high risk of developing other atherosclerotic diseases [9][10][11].…”