title: Best reproducibility of the ankle-arm index was calculated using Doppler and dividing highest ankle pressure by highest arm pressure.
abstract: OBJECTIVE
  To investigate which method of ankle-arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility.
  
  
  METHODS
  In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated.
  
  
  RESULTS
  The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap.
  
  
  CONCLUSIONS
  To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
authors.forename: Femke
authors.initials: F
authors.lastname: Atsma
authors.forename: Marie-Louise E L
authors.initials: ML
authors.lastname: Bartelink
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply; D001158:Arteries; D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards*; D001916:Brachial Artery / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D015588:Observer Variation; D017698:Postmenopause; D015203:Reproducibility of Results; D013599:Systole; D016909:Tibial Arteries / Q000502:physiology; D018608:Ultrasonography, Doppler / Q000379:methods*