The Relationship Between High Pulse Pressure and Low Ankle-Brachial Index. Potential Utility in Screening for Peripheral Artery Disease in Population-Based Studies

被引：3

作者：

Del Brutto O.H. ^{[1
,6
]}

Mera R.M. ^{[2
]}

Sedler M.J. ^{[3
]}

Gruen J.A. ^{[3
]}

Phelan K.J. ^{[3
]}

Cusick E.H. ^{[3
]}

Zambrano M. ^{[4
]}

Brown D.L. ^{[5
]}

机构：

[1] School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil

[2] Gastroenterology Department, Vanderbilt University, Nashville, TN

[3] School of Medicine, Stony Brook University, New York, NY

[4] Community Center, Atahualpa

[5] Cardiovascular Division, Washington University School of Medicine, St. Louis, MO

[6] Air Center 3542, PO Box 522970, Miami, 33152-2970, FL

来源：

High Blood Pressure & Cardiovascular Prevention | 2015年 / 22卷 / 3期

关键词：

Ankle-brachial index; Atahualpa Project; Peripheral artery disease; Population-based study; Pulse pressure;

D O I：

10.1007/s40292-015-0103-6

中图分类号：

学科分类号：

摘要：

Introduction: The ankle-brachial index (ABI) is a reliable screening procedure for peripheral artery disease detection. However, ABI testing is time-consuming and requires trained personnel, which may preclude its routine use in population-based surveys. Preliminary data suggest a relationship between ABI values and pulse pressure (PP) levels. Aim: To assess whether PP calculation might help to detect persons who need ABI screening in population-based studies. Methods: All Atahualpa residents aged ≥60 years were identified during a door-to-door survey and invited to undergo ABI testing. Non-consented persons and those with ABI ≥1.4 were excluded. Using generalized linear and logistic regression models adjusted for demographics and cardiovascular risk factors, as well as receiver operator characteristics curve analysis, we evaluated the association between PP values and ABI, as well as the reliability of PP to identify candidates for ABI testing. Results: Out of 239 participants (mean age 70 ± 8 years, 62 % women), 46 (19 %) had an ABI ≤0.9 and 136 (57 %) had PP >65 mmHg, with a negative relationship between them (R = −0.386, p < 0.0001). A PP >65 mmHg was associated with an ABI ≤ 0.9 in the logistic regression model (OR 3.46, 95 % CI 1.07–11.2, p = 0.038). Continuous PP levels also correlated negatively with ABI (β −0.0014, 95 % CI −0.0024 to −0.0004, p = 0.005). The sensitivity of a PP >65 mmHg to predict a low ABI was 85 %, and the specificity was 50 %. In contrast, the sensitivity of blood pressure ≥140/90 mmHg was 27 % and the specificity was 10 %. The area under the curve for the predictive value of a PP >65 mmHg was 0.673 (95 % CI 0.609–0.736), and that of a blood pressure ≥140/90 mmHg was 0.371 (95 % CI 0.30–0.443), with a significant difference between them (p < 0.0001). Conclusions: PP calculation may be a simple tool to detect candidates for ABI testing in population-based studies. © 2015, Springer International Publishing Switzerland.

引用

页码：275 / 280

页数：5

共 25 条

[1]

Murabito J.M., Evans J.C., Nieto K., Larson M.G., Levy D., Wilson P.W., Prevalence and clinical correlates of peripheral artery disease in the Framingham Offspring Study, Am Heart J., 143, pp. 961-965, (2002)

[2]

Alzamora M.T., Fores R., Pera G., Toran P., Heras A., Sorribes M., Baena-Diez J.M., Urrea M., Alegre J., Viozquez M., Vela C., Ankle-brachial index and the incidence of cardiovascular events in the Mediterranean low cardiovascular risk population ARTPER cohort, BMC Cardiovasc Disord., 13, (2013)

[3]

Fowkes F.G., Rudan D., Rudan I., Aboyans V., Denenberg J.O., McDermott M.M., Norman P.E., Sampson U.K., Williams L.J., Mensah G.A., Criqui M.H., Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis, Lancet, 382, pp. 1329-1340, (2013)

[4]

McDermott M.M., Greenland P., Liu K., Guralnik J.M., Criqui M.H., Dolan N.C., Chan C., Celic L., Pearce W.H., Schneider J.R., Sharma L., Clark E., Gibson D., Martin G.J., Leg symptoms in peripheral artery disease. Associated clinical characteristics and functional impairment, JAMA, 286, pp. 1599-1606, (2001)

[5]

Aboyans V., Criqui M.H., Abraham P., Allison M.A., Vreager M.A., Dihem C., Fowkes F.G., Hiatt W.R., Lacroix P., Marin B., McDermott M.M., Norgren L., Pande R.L., Preux P.M., Stoffers H.E., Treat-Jacobnson D., Measurement and interpretation of the ankle-brachial index. A scientific statement from the American Heart Association, Circulation, 126, pp. 2890-2909, (2012)

[6]

Ankle Brachial Index Collaboration, Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality, JAMA, 300, pp. 197-208, (2008)

[7]

Moyer V.A., US, Preventive Services Task Force. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index in adults: U.S. Preventive Services Task Force Recommendation Statement, Ann Intern Med, 159, pp. 342-348, (2013)

[8]

Salameh M.J., Rundek T., Boden-Albala B., Jin Z., Ratchford E.V., Di Tulio M.R., Homma S., Sacco R.L., Self-reported peripheral artery disease predicts future vascular events in a community-based cohort, J Gen Intern Med, 23, pp. 1423-1428, (2008)

[9]

Del Brutto O.H., Sedler M.J., Zambrano M., Mera R.M., Phelan K.J., Gruen J.A., Cusick E.H., Moral C.F., Del B.V.J., Castillo P.R., Brown D.L., Comparison of field questionnaires with the ankle-brachial index for the detection of Peripheral artery disease. A population-based study in rural Ecuador, Int J Cardiol, 177, pp. 703-704, (2014)

[10]

Zhan Y., Yu J., Chen R., Sun Y., Fu Y., Zhang L., Li S., Zhang F., Hu D., Prevalence of low ankle brachial index and its association with pulse pressure in an elderly Chinese population: a cross-sectional Study, J Epidemiol, 22, pp. 454-461, (2012)

← 1 2 3 →