title: Prognostic value of low ankle-brachial index in patients   with hypertension and acute coronary syndromes.
abstract: BACKGROUND
  Peripheral arterial disease (PAD) is associated with an increased risk of cardiovascular morbidity and mortality. Nevertheless, many patients are asymptomatic, and this condition frequently remains underdiagnosed. An ankle-brachial index (ABI) of less than 0.9 is a noninvasive and simple marker in the diagnosis of PAD and is also predictive of target organ damage in hypertension. The prognostic value of such measurements in hypertensive patients with acute coronary syndrome (ACS) is unknown.
  
  
  METHODS
  The Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome registry is a multicentre, observational and prospective study that aims to describe the prevalence of and prognosis for PAD, diagnosed by ABI in hypertensive patients with ACS.
  
  
  RESULTS
  One thousand one hundred and one hypertensive patients with ACS and at least 40 years of age were prospectively studied. Mean age of the population was 67.4 (11.4) years, and 67.7% were men. The prevalence of ABI less than 0.9 was 42.6% (469 patients). This subgroup was significantly older, had a higher prevalence of diabetes, previous coronary heart disease or stroke, left ventricular hypertrophy and more severe coronary lesions. Hospital mortality was higher in hypertensive patients with ABI less than 0.9 (2.3 vs. 0.2%; P< 0.01). An ABI less than 0.9 was associated with an increased risk of heart failure after ACS (odds ratio, 1.4; P=0.04), higher hospital mortality (odds ratio, 13.0; P=0.03) and the composite endpoint of mortality, heart failure and angina (odds ratio, 1.4; P=0.03).
  
  
  CONCLUSIONS
  Asymptomatic PAD is highly prevalent in hypertensive patients with ACS. An ABI less than 0.9 identifies a subset of patients with more extensive target organ damage and higher risk of hospital cardiovascular complications after an ACS.
authors.affiliation: Hospital Universitario de San Juan, Alicante, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Morillas
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
authors.forename: Juan
authors.initials: J
authors.lastname: Quiles
authors.forename: Josep
authors.initials: J
authors.lastname: Guindo
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.forename: Pilar
authors.initials: P
authors.lastname: Mazón
authors.forename: Vicente
authors.initials: V
authors.lastname: Nieto
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Isidoro
authors.initials: I
authors.lastname: González-Maqueda
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology