The variability of ankle–arm blood pressure difference and ankle–brachial index in treated hypertensive patients

Cao, Kaiwu; Xu, Jiahua; Sun, Hanjun; Li, Ping; Li, Juxiang; Cheng, Xiaoshu; Su, Hai

doi:10.1016/j.jash.2014.07.030

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Generally, older studies used Doppler probes and strain-gauge plethysmography techniques. [15][16][17][18][19] Newer studies using validated oscillometric sphygmomanometers found similar arm-leg blood pressure differences to those using other devices [4,5,10], although the statistical heterogeneity across studies was reduced. When measuring armleg blood pressure differences, for example in the assessment of peripheral vascular disease, the present data suggest similar differences can be observed using sequential versus simultaneous methods.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…A number of previous studies have compared blood pressure readings made in the leg to those in the upper arm. [4][5][6] However, these studies have examined different populations using varying measurement techniques, so it is unclear what standard blood pressure difference between upper and lower limbs should be expected. It is also unclear how diagnostic and treatment thresholds should be adjusted when leg blood pressure measurements are relied upon to guide treatment.…”

Section: Introductionmentioning

confidence: 99%

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Defining the relationship between arm and leg blood pressure readings

Sheppard

Albasri

Franssen

et al. 2019

Journal of Hypertension

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To define the relationship between arm and leg blood pressure to inform the interpretation of leg blood pressure readings in routine clinical practice where arm readings are not available. Methods: Systematic review of all existing studies comparing arm and leg blood pressure measurements. A search strategy was designed in MEDLINE and adapted to be run across six further databases. Articles were deemed eligible for inclusion if they measured and reported arm and leg blood pressure taken in the supine position and/or the difference between the two. Mean values for arm-leg blood pressure difference and measures of precision (95% confidence intervals [CI] or standard deviation) were extracted and entered into a random-effects meta-analysis. Results: A total of 887 articles were screened and 44 were included in the descriptive analyses, including 9,771 patients. In the general population, ankle systolic blood pressure was 17.0 mmHg (95%CI 15.4 to 21.3 mmHg) higher than arm blood pressure in the supine position. For diastolic blood pressure, there was no difference between arm and ankle blood pressure (-0.3 mmHg, 95%CI-1.5 to 1.0 mmHg). In patients with vascular disease, systolic blood pressure was-33.3 mmHg (95%CI-59.1 to-7.6 mmHg) lower in the ankle compared to the arm. Conclusions: This is the first review to provide empirical data defining the difference between blood pressure in the arm and leg in the general population. Findings suggest a diagnostic threshold of 155/90 mmHg could be used for diagnosing hypertension when only ankle measurements are available in routine practice.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defining the relationship between arm and leg blood pressure readings

Sheppard

Albasri

Franssen

et al. 2019

Journal of Hypertension

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“…Due to systolic or diastolic blood pressure, blood pressure of upper or lower limbs shown different clinical applications when evaluating cardiovascular function. As reported in the study (Clark et al, 2012a;Chen et al, 2012;Cao et al, 2014), the differential pressure of upper limb systolic pressure is more than 15 mmHg, reminding patients to conduct further vascular assessment, which is a useful indicator of vascular disease and death risk. Based on the above theoretical model, as shown in the Figure 1C, we derive blood flow equation for different times in one cardiac cycle considering the different distributions of blood pressure and pulse wave of four limbs, then obtain the average blood flow in one cardiac cycle.…”

Section: Establishment Of Blood Flow Models Based On Blood Pressure A...mentioning

confidence: 88%

“…Clark et al (2012a) reported that patients with this difference require further vascular evaluation, thereby suggesting that this signal is a useful indicator for vascular diseases and risk of death. Chen, Su, Clark, and others (Clark et al, 2007;2012b;2012a;Chen et al, 2012;Sheng et al, 2013;Cao et al, 2014;Su et al, 2014) have reported that the upper limb diastolic pressure difference and lower limb diastolic pressure difference of more than 10 mmHg or 15 mmHg correspond to statistical differences in the statistical analysis of peripheral vascular disease, CVDs mortality, and all-cause mortality. Therefore, the signal data of blood pressure and pulse wave of four limbs must be used to improve the accuracy of the HDIs calculation model.…”

Section: Introductionmentioning

confidence: 98%

Non-invasive hemodynamic diagnosis based on non-linear pulse wave theory applied to four limbs

Song

Liu²,

Wang³

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Hemodynamic diagnosis indexes (HDIs) can comprehensively evaluate the health status of the cardiovascular system (CVS), particularly for people older than 50 years and prone to cardiovascular disease (CVDs). However, the accuracy of non-invasive detection remains unsatisfactory. We propose a non-invasive HDIs model based on the non-linear pulse wave theory (NonPWT) applied to four limbs.Methods: This algorithm establishes mathematical models, including pulse wave velocity and pressure information of the brachial and ankle arteries, pressure gradient, and blood flow. Blood flow is key to calculating HDIs. Herein, we derive blood flow equation for different times of the cardiac cycle considering the four different distributions of blood pressure and pulse wave of four limbs, then obtain the average blood flow in a cardiac cycle, and finally calculate the HDIs.Results: The results of the blood flow calculations reveal that the average blood flow in the upper extremity arteries is 10.78 ml/s (clinically: 2.5–12.67 ml/s), and the blood flow in the lower extremity arteries is higher than that in the upper extremity. To verify model accuracy, the consistency between the clinical and calculated values is verified with no statistically significant differences (p < 0.05). Model IV or higher-order fitting is the closest. To verify the model generalizability, considering the risk factors of cardiovascular diseases, the HDIs are recalculated using model IV, and thus, consistency is verified (p < 0.05 and Bland-Altman plot).Conclusion: We conclude our proposed algorithmic model based on NonPWT can facilitate the non-invasive hemodynamic diagnosis with simpler operational procedures and reduced medical costs.

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“…A blood pressure difference between arms has been associated with subclavian stenosis, peripheral artery disease, cardiovascular mortality and all-cause mortality [1, 8–11], meanwhile recent studies on inter-leg systolic blood pressure difference have added a new evidence to this concept [12–14]. The meta-analysis reported by Cao showed that inter-arm systolic blood pressure difference ≥15 mmHg might help to predict increased cardiovascular mortality (HR 1.94, 95% CI 1.12–3.35, P < 0.05) in the community populations [15].…”

Section: Introductionmentioning

confidence: 99%

Association of simultaneously measured four-limb blood pressures with cardiovascular function: a cross-sectional study

Song¹,

Li²,

Qiao³

et al. 2016

BioMed Eng OnLine

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BackgroundSimultaneous measurement of four-limb blood pressures can improve the accuracy of cardiovascular disease diagnosis. This study aims to investigate the association of simultaneously measured four-limb blood pressures with cardiovascular function as the non-invasive diagnostic method of cardiovascular disease in primary care.Methods229 subjects (62 males, mean age, 63.50 ± 11.13 years; 167 females, mean age, 59.47 ± 7.33 years) were enrolled. Four-limb blood pressure measurements were simultaneously performed using a blood pressure and pulse monitor device in the supine position. Cardiac functional parameters were also measured by using a cardiac hemodynamic detector in the same position. Data were statistically analyzed with SPSS15.0.ResultsThe mean age of the 229 subjects was 60.56 ± 8.68 years. Cardiovascular functional parameters decreased with age and body mass index (BMI), only the total peripheral resistance (TPR) was in contrast. Age, BMI, left ankle diastolic pressure (LADP), high arm mean arterial pressure (HARMAP), left arm diastolic pressure (LARDP) and right ankle diastolic pressure (RADP) were significantly correlated with cardiovascular functional parameters. Cardiovascular functional parameters have significant differences with inter-arm difference in systolic blood pressure (SBP) between ≥10 and <10 mmHg, inter-ankle difference in SBP between ≥15 and ≥20 mmHg, inter-ankle difference in SBP between ≥15 and <10 mmHg and right ankle brachial index (RABI) between ≤0.9 and ≥1.0. After excluding 99 hypertensive patients, a part of cardiovascular functional parameters has still significant differences with inter-arm difference in SBP between ≥10 and ≥15 mmHg and RABI between ≤0.9 and ≥1.0.ConclusionAge, BMI, LADP, HARMAP, LARDP and RADP were the determinants of cardiovascular functional parameters. In addition, a part of cardiovascular functional parameter is associated with inter-arm difference in SBP ≥10 mmHg, inter-ankle difference in SBP ≥15 mmHg and RABI ≤0.9, while these differences still existed after excluding 99 hypertensive patients. Hence, simultaneous measurement of four-limb blood pressures has become feasible and useful approach to the non-invasive diagnostic method of cardiovascular disease in primary care.

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The variability of ankle–arm blood pressure difference and ankle–brachial index in treated hypertensive patients

Cited by 7 publications

References 19 publications

Defining the relationship between arm and leg blood pressure readings

Defining the relationship between arm and leg blood pressure readings

Non-invasive hemodynamic diagnosis based on non-linear pulse wave theory applied to four limbs

Association of simultaneously measured four-limb blood pressures with cardiovascular function: a cross-sectional study

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