Via practica 6/2025
The benefit of determining blood pressure indices in the diagnosis of peripheral arterial disease and prediction of patient mortality – results of clinical studies
Several studies have compared systolic blood pressure (SBP) measured at the arm and at the ankle in terms of diagnosing peripheral arterial disease (PAD) and subsequent mortality, with the ankle-brachial index (ABI) having found wide application in clinical practice. In the present work, we report on the results of the analysis of three large prospective clinical studies, which also pointed out the benefit of other indices in predicting mortality. The input BP indices included SBP and diastolic BP (DBP) measured at the arm, pulse pressure (SBP minus DBP measured at the arm), ankle SBP, ankle-brachial index (ABI) – which is defined as the ratio of blood pressure measured at the lower limb (ankle) to blood pressure measured at the upper limb’s arm and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). These measurements were categorized into four groups using quartiles. The outcomes were PAD (the first occurrence of either peripheral revascularization or lower-limb amputation for vascular disease), the composite of PAD or death, and all-cause death. Among 40 747 participants without baseline PAD (age 65.6 years, men 68.3 %, diabetes 50.2 %) from 53 countries, 1071 (2.6 %) developed PAD, and 4955 (12.2 %) died during years of follow-up. Incident PAD progressively rose with higher arm BP indices and fell with ankle BP indices. The strongest relationship was noted for ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, adjusted hazard ratios (95 % CI) for each lower fourth were 1.64 (1.31–2.04), 2.59 (2.10–3.20), and 4.23 (3.44–5.21) for ankle SBP; 1.19 (0.95–1.50), 1.66 (1.34–2.05), and 3.34 (2.75–4.06) for ABI; and 1.41 (1.11–1.78), 2.04 (1.64–2.54), and 3.63 (2.96–4.45) for APPD. Similar patterns were observed for mortality. Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality.
Keywords: peripheral artery disease, arm blood pressure and indices, ankle blood pressure and indices, pulse pressure, ankle-brachial index, all-cause mortality
