Abstract
The ankle-brachial blood pressure index (ABI) predicts cardiovasular disease. To our knowledge, no study has compared manual ABI measurements with an automated electronic oscillometric method in a population sample. We enrolled 946 residents (50.8% women; mean age, 43.5 years) from 8 villages in JingNing County, Zhejiang Province, P.R. China. We computed ABI as the ratio of ankle-to-arm systolic blood pressures from consecutive auscultatory or Doppler measurements at the posterior tibial and brachial arteries. We also used an automated oscillometric technique with simultaneous ankle and arm measurements (Colin VP-1000). Mean ABI values were significantly higher on Doppler than auscultatory measurements (1.15 vs. 1.07; p<0.0001) with intermediate levels on oscillometric determination (1.12; p<0.0001 vs. Doppler). The differences among the three measurements were not homogeneously distributed across the range of ABI values. Doppler and oscillometric ABIs were similar below 1.0, whereas above 1.2 Doppler and auscultatory ABIs were comparable. In Bland and Altman plots, the correlation coefficient between differences in Doppler minus oscillometric ABI and ABI level was 0.21 (p<0.0001). The corresponding correlation coefficient for Doppler minus auscultatory ABI was −0.13 (p<0.0001). In conclusion, automated ABI measurements are feasible in large-scale population studies. However, the small differences in ABI values between manual and oscillometric measurements depend on ABI level and must be considered in the interpretation of study results.
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Belch JJ, Topol EJ, Agnelli G, et al: Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med 2003; 163: 884–892.
Khan NA, Rahim SA, Anand SS, Simel DL, Panju A : Does the clinical examination predict lower extremity peripheral arterial disease ? JAMA 2006; 295: 536–546.
Doobay AV, Anand SS : Sensitivity and specificity of the ankle-brachial index to predict future cardiovascular outcomes: a systematic review. Arterioscler Thromb Vasc Biol 2005; 25: 1463–1469.
Resnick HE, Lindsay RS, McDermott MM, et al: Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation 2004; 109: 733–739.
Newman AB, Shemanski L, Manolio TA, et al, The Cardiovascular Health Study Group: Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 1999; 19: 538–545.
Ono K, Tsuchida A, Kawai H, et al: Ankle-brachial blood pressure index predicts all-cause and cardiovascular mortality in hemodialysis patients. J Am Soc Nephrol 2003; 14: 1591–1598.
Kaiser V, Kester AD, Stoffers HE, Kitslaar PJ, Knottnerus JA : The influence of experience on the reproducibility of the ankle-brachial systolic pressure ratio in peripheral arterial occlusive disease. Eur J Vasc Endovasc Surg 1999; 18: 25–29.
Cortez-Cooper MY, Supak JA, Tanaka H : A new device for automatic measurements of arterial stiffness and ankle-brachial index. Am J Cardiol 2003; 91: 1519–1522.
Li Y, Staessen JA, Li LH, et al: Blood pressure and urinary sodium excretion in relation to the A−1984G adrenomedullin polymorphism in a Chinese population. Kidney Int 2006; 69: 1153–1158.
Li Y, Wang JG, Dolan E, et al: Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 2006; 47: 359–364.
Resnick HE, Foster GL : Prevalence of elevated ankle-brachial index in the United States 1999 to 2002. Am J Med 2005; 118: 676–679.
Bland JM, Altman DG : Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.
Beckman JA, Higgins CO, Gerhard-Herman M : Automated oscillometric determination of the ankle-brachial index provides accuracy necessary for office practice. Hypertension 2006; 47: 35–38.
Salles-Cunha SX, Vincent DG, Towne JB, Bernhard VM : Noninvasive ankle pressure measurements by oscillometry. Tex Heart Inst J 1982; 9: 349–357.
Adiseshiah M, Cross FW, Belsham PA : Ankle blood pressure measured by automatic oscillotonometry: a comparison with Doppler pressure measurements. Ann R Coll Surg Engl 1987; 69: 271–273.
Ramanathan A, Conaghan PJ, Jenkinson AD, Bishop CR : Comparison of ankle-brachial pressure index measurements using an automated oscillometric device with the standard Doppler ultrasound technique. ANZ J Surg 2003; 73: 105–108.
O'Brien E, Mee F, Atkins N, O'Malley K : Short report: accuracy of the Dinamap portable monitor, model 8100 determined by the British Hypertension Society protocol. J Hypertens 1993; 11: 761–763.
Rose KM, Arnett DK, Ellison RC, Heiss G : Skip patterns in DINAMAP-measured blood pressure in 3 epidemiological studies. Hypertension 2000; 35: 1032–1036.
Stoffers HE, Kester AD, Kaiser V, Rinkens PE, Kitslaar PJ, Knottnerus JA : The diagnostic value of the measurement of the ankle-brachial systolic pressure index in primary health care. J Clin Epidemiol 1996; 49: 1401–1405.
Su HM, Voon WC, Lin TH, et al: Ankle-brachial pressure index measured using an automated oscillometric method as a predictor of the severity of coronary atherosclerosis in patients with coronary artery disease. Kaohsiung J Med Sci 2004; 20: 268–272.
Hasimu B, Li J, Nakayama T, et al: Ankle brachial index as a marker of atherosclerosis in Chinese patients with high cardiovascular risk. Hypertens Res 2006; 29: 23–28.
Li Y, Wang JG, Gao PJ, et al: Interaction between body mass index and alcohol intake in relation to blood pressure in HAN and SHE Chinese. Am J Hypertens 2006; 19: 448–453.
Kimura A, Hashimoto J, Watabe D, et al: Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a Japanese population in Ohasama, Japan. J Hypertens 2004; 22: 2277–2283.
Li B, Gao H, Li X, Liu Y, Wang M : Correlation between brachial-ankle pulse wave velocity and arterial compliance and cardiovascular risk factors in elderly patients with atherosclerosis. Hypertens Res 2006; 29: 309–314.
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Pan, CR., Staessen, J., Li, Y. et al. Comparison of Three Measures of the Ankle-Brachial Blood Pressure Index in a General Population. Hypertens Res 30, 555–561 (2007). https://doi.org/10.1291/hypres.30.555
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DOI: https://doi.org/10.1291/hypres.30.555
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