Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population

Abstract

Background Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes. Methods We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded. Results A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics. Conclusions Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population.

Early Atherosclerosis in Familial Hypercholesterolemia Patients: Significance of Vascular Markers for Risk Stratification

“…A study by Emanuelsson et al showed that low ABIs may be associated with an increased risk of MI, even after adjusting for risk factors, which further promotes the use of the ABI as a risk assessment tool [ 28 ]. Multiple CVD risk factors are hypothesized to affect ABI [ 29 ]. In this study, we tested which risk factors had the greatest influence on the ABI.…”

Early atherosclerosis in familial hypercholesterolemia patients: significance of vascular markers for risk stratification

“…A study by Emanuelsson et al showed that low ABIs may be associated with an increased risk of MI, even after adjusting for risk factors, which further promotes the use of the ABI as a risk assessment tool (26). Multiple CVD risk factors are hypothesized to affect ABI (27). In this study, we tested which risk factors had the greatest in uence on the ABI.…”

A cross-sectional study explores the association of physical activity with the severity of peripheral arterial disease from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…Patients are diagnosed with PAD when their ABI values are ≤0.9 on either the left or right limb. [ 3 ] In terms of PAD categories, ABI values 0.7 to <0.90, 0.4 to <0.7, and <0.4 are considered mild, moderate, and severe PAD, respectively. When the ABI is between 0.91 and .99, it is considered borderline, and between 1.0 and 1.4 is considered normal, respectively.…”

“…An ABI value >1.4 is an indication of the presence of stiff blood vessels, which is not considered PAD. [3][4][5]…”

“…[2] ABI values between 1.0 and 1.4 are considered normal, whereas values <1.0 or >1.4 are considered abnormal. [3][4][5] The hazard ratios of deaths in men and women due to cardiovascular reasons were higher in people who had ABI values <1.0 or >1.4, which makes the ABI a suitable predictor of cardiovascular mortality or events. In people with ABI values <1, the cardiovascular mortality rates in men and women were 18.7% and 12.6%, respectively.…”