The Relationship Between High Pulse Pressure and Low Ankle-Brachial Index. Potential Utility in Screening for Peripheral
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ORIGINAL RESEARCH ARTICLE
The Relationship Between High Pulse Pressure and Low AnkleBrachial Index. Potential Utility in Screening for Peripheral Artery Disease in Population-Based Studies Oscar H. Del Brutto1,6 • Robertino M. Mera2 • Mark J. Sedler3 • Jadry A. Gruen3 • Kelsie J. Phelan3 • Elizabeth H. Cusick3 • Mauricio Zambrano4 • David L. Brown5
Received: 9 March 2015 / Accepted: 12 May 2015 Springer International Publishing Switzerland 2015
Abstract 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 C60 years were identified during a door-to-door survey and invited to undergo ABI testing. Non-consented persons and those with ABI C1.4 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. & Oscar H. Del Brutto [email protected] 1
School of Medicine, Universidad Espı´ritu Santo, Ecuador, Guayaquil, Ecuador
2
Gastroenterology Department, Vanderbilt University, Nashville, TN, USA
3
School of Medicine, Stony Brook University, New York, NY, USA
4
Community Center, Atahualpa, Ecuador
5
Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
6
Air Center 3542, PO Box 522970, Miami, FL 33152-2970, USA
Results Out of 239 participants (mean age 70 ± 8 years, 62 % women), 46 (19 %) had an ABI B0.9 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 B 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 (b 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 C140/90 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 C140/90 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. Keywords Pulse pressure Ankle-brachial index Peripheral artery disease Population-based study Atahualpa Project
1 Introduction Peripheral artery disease (PAD) is a well-known marker of systemic atherosclerosis and h
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