Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.
BACKGROUND
Hypertension is an established risk factor for peripheral arterial disease (PAD), but the prevalence of this condition in hypertensive patients without comorbidities is unknown.


METHODS
In this study, we assess the prevalence and factors associated with PAD, and the usefulness of ankle-brachial index (ABI) in evaluating cardiovascular risk in hypertensive patients without cardiovascular or renal disease or previously known diabetes mellitus. We measured ABI in 972 nonclaudicant patients with hypertension, newly diagnosed glucose disorders, metabolic syndrome, obesity or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System.


RESULTS
The prevalence of PAD (defined as ABI < or =0.90) and borderline PAD (defined as ABI 0.91-1.00) in hypertensive patients was 7.3% (39/532) and 23.7% (126/532), respectively. In a multivariate model, hypertension remained an independent factor associated with PAD (adjusted odds ratio 3.20; 95% confidence interval 1.56-6.58). There was no association between PAD and metabolic risk factors. SBP and pulse pressure increased linearly across subgroups of ABI (normal 0.91-1.00 and < or =0.90) in hypertensive patients (P < 0.001).


CONCLUSIONS
Subclinical PAD is common in hypertensive patients even without comorbidities. The measurement of ABI is an efficient method to identify patients with increased cardiovascular risk and worth performing to hypertensive patients, particularly those with pulse pressure above 65 mmHg. Uniform criterions of defining PAD and borderline PAD would aid physicians in clinical decision-making.
Korhonen
Päivi E
PE
Central Satakunta Health Federation of Municipalities, Harjavalta, Finland. paivi.e.korhonen@fimnet.fi
Syvänen
Kari T
KT
Vesalainen
Risto K
RK
Kantola
Ilkka M
IM
Kautiainen
Hannu
H
Järvenpää
Salme
S
Aarnio
Pertti T
PT
D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D015897:Comorbidity; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
D008055:Lipids