Measurement of blood pressure, ankle blood pressure and calculation of ankle brachial index in general practice.
BACKGROUND
Low ankle brachial index (ABI) is a sensitive measure of 'burden' of atherosclerosis, indicating cardiovascular risk of the asymptomatic patient. Conventionally, ABI values <0.90 are considered pathological, indicating peripheral arterial disease.


OBJECTIVE
The purpose of this study was to establish whether GPs after a short training course can reliably determine ABI compared to assessment in a specialized hospital department.


METHODS
Epidemiological observational study.


METHODS
A total of 6 GPs and 12 general practice nurses from six practices were recruited for the study. Doppler measurements and ABI calculations were performed according to guidelines used by the Department of Nuclear Medicine, Odense University Hospital.


RESULTS
On average, blood pressure measurements in general practice yielded lower values than those measured at the hospital. Differences in brachial and ankle blood pressure were -7 mmHg (-43 to 30 mmHg) and -14 mmHg (-63 to 33 mmHg), respectively. Sensitivity and specificity of ABI in general practice were 1.00 (0.87-1.00) and 0.79 (0.69-0.88), respectively. Predictive value of ABI measured <0.9 in general practice was 0.62 (0.46-0.76).


CONCLUSIONS
Findings in general practice and at the Department of Nuclear Medicine were concordant with regard to the threshold value of ABI 0.9. However, this study does not warrant a recommendation of doppler measurements or assessment of ABI as screening or diagnostic procedure due to low specificity of assessments in general practice. Our results indicate a high number of false-positive tests if the method is applied for screening in general practice.
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, DK-5000 Odense C, Denmark. jnexoe@health.sdu.dk
Jørgen
J
Nexøe
Bent
B
Damsbo
Jens Otto
JO
Lund
Anders
A
Munck
D000842:Ankle; D055109:Ankle Brachial Index; D001795:Blood Pressure Determination; D002983:Clinical Competence; D005189:False Positive Reactions; D058006:General Practice / Q000193:education; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis*; D011237:Predictive Value of Tests