Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Ankle and exercise blood pressures as predictors of coronary morbidity and mortality in a prospective follow-up study

Journal of Human Hypertension volume 24, pages 577–584 (2010)Cite this article

Subjects

Abstract

Elevated ankle blood pressure (ABP) may be one of the earliest signs of subclinical atherosclerosis. However, its behavior in different degrees of atherosclerotic vascular damage has not been well characterized. We examined the association of ABP and brachial exercise blood pressure with the incidence of future coronary events. A cohort of 3808 consecutive ambulatory persons (mean age 50 years, 34% women), referred to a symptom-limited exercise test and free of cardiovascular events at baseline, was prospectively followed up for 15 years. Altogether, 383 (80 fatal and 303 non-fatal) incident coronary events occurred. Cox proportional hazards models, adjusting for several conventional risk factors, were used to analyse the independent association of ABP with the risk of an incident coronary heart disease (CHD) event. Persons with normal ankle, brachial resting and brachial exercise blood pressures were taken as the reference group. Other groups were formed on the basis of ankle and exercise blood pressures and compared with the reference group. Even in persons among whom the elevated ABP was the only abnormal finding, the multivariate adjusted hazard ratio (HR) of a future CHD event was significantly elevated (HR=1.60, 95% confidence interval 1.20–2.14, P<0.0001). In general, the HRs were higher for fatal events than for non-fatal events. The measurement of ABP could be an inexpensive and non-invasive tool to detect elevated risk of a CHD event.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. O’Hare AM, Katz R, Shlipak MG, Cushman M, Newman AB . Mortality and cardiovascular risk across the ankle-arm index spectrum. Results from the cardiovascular health study. Circulation 2006; 113: 388–393.

    Article  PubMed  Google Scholar 

  2. Zheng ZJ, Sharrett AR, Chambless LE, Rosamond WD, Nieto FJ, Sheps DS et al. Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis 1997; 131: 115–125.

    Article  CAS  PubMed  Google Scholar 

  3. Lee AJ, Price JF, Russell MJ, Smith FB, Wijk MCW, Fowkes FGR . Improved prediction of fatal myocardial infarction using the Ankle Brachial Index in addition to conventional risk factors. The Edinburg Artery Study. Circulation 2004; 110: 3075–3080.

    Article  CAS  PubMed  Google Scholar 

  4. Lamina C, Meisinger C, Heid IM, Löwel H, Rantner B, Koenig W et al. Association of ankle-brachial index and plaque in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up. Eur Heart J 2006; 27: 2580–2587.

    Article  PubMed  Google Scholar 

  5. Diehm C, Lange S, Darius H, Pittrow D, von Stritzky B, Tepohl G et al. Association of low ankle brachial index with high mortality in primary care. Eur Heart J 2006; 27: 1743–1749.

    Article  PubMed  Google Scholar 

  6. Fowkes FG, Low LP, Tura S, Kozak J . Ankle-brachial index and extent of atherotrombosis in 8891 persons with or at risk of vascular disease: results of the international AGATHA study. Eur Heart J 2006; 27: 1861–1867.

    Article  PubMed  Google Scholar 

  7. Weatherley BD, Nelson JJ, Heiss G, Chambless LE, Sharrett AR, Nieto FJ et al. The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study, 1987–2001. BMC Cardiovasc Disord 2007; 7: 3.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR 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.

    Article  PubMed  Google Scholar 

  9. Aboyans V, Lacroix P, Postil A, Guilloux J, Rollé F, Cornu E et al. Subclinical peripheral arterial disease and incompressible ankle arteries are both long-term prognostic factors in persons undergoing coronary artery bypass grafting. J Am Coll Cardiol 2005; 46: 815–820.

    Article  PubMed  Google Scholar 

  10. McDermott MM, Liu K, Criqui MH, Ruth K, Goff D, Saad MF et al. Ankle-brachial index and subclinical cardiac and carotid disease. The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2005; 162: 33–41.

    Article  PubMed  Google Scholar 

  11. Sutton-Tyrell K, Venkitachalam L, Kanaya AM, Boudreau R, Harris T, Thompson T et al. Relationship of ankle blood pressures to cardiovascular events in older adults. Stroke 2008; 39: 863–869.

    Article  Google Scholar 

  12. Hietanen H, Pääkkönen R, Salomaa V . Ankle blood pressure as a predictor of total and cardiovascular mortality. BMC Cardiovasc Disord 2008; 8: 3.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nordic Medico-Statistical Committee (NOMESCO). NOMESCO Classification of Surgical Procedures 59: 2001.

  14. Blair SN, Kampert JB, Kohl III HW, Barlow CE, Macera CA, Paffenbarger RS et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276: 205–210.

    Article  CAS  PubMed  Google Scholar 

  15. Church TS, Cheng YJ, Earnest CP, Barlow CE, Gibbons LW, Priest EL et al. Exercise capacity and body composition as predictors of mortality among men with diabetes. Diabetes Care 2004; 27: 83–88.

    Article  PubMed  Google Scholar 

  16. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K . Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993; 328: 533–537.

    Article  CAS  PubMed  Google Scholar 

  17. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE . Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793–798.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Physiology, Deaconess Institute, Helsinki, Finland

    H Hietanen

  2. THL-National Institute for Health and Welfare, Helsinki, Finland

    R Pääkkönen & V Salomaa

Authors
  1. H Hietanen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Pääkkönen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V Salomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H Hietanen.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hietanen, H., Pääkkönen, R. & Salomaa, V. Ankle and exercise blood pressures as predictors of coronary morbidity and mortality in a prospective follow-up study. J Hum Hypertens 24, 577–584 (2010). https://doi.org/10.1038/jhh.2009.102

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2009.102

Keywords

This article is cited by

Search

Advanced search

Quick links