DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170040

Ankle brachial pressure index to assess atherosclerotic risk in hypertensive subjects

Santosh B. Salagre, Shobha M. Itolikar, Radhika J. Chavan

Abstract


Background: This research was planned to study correlation of ankle brachial pressure index (ABPI) with clinical features, laboratory investigations and anthropometric measurements in patients of essential hypertension and to establish association of atherosclerosis risk in hypertensive subject.

Methods: This prospective observational year-long study was conducted after the institutional ethics committee approval in outpatient department of a tertiary care hospital. 153 adult non-pregnant patients were enrolled after written informed consent. Out of these, 51 patients each were of stage I hypertension, stage II hypertension and normal blood pressure. The ABPI were measured in the posterior tibial arteries using a Doppler ultrasound probe. The detailed demographic and anthropometric data was entered in proforma and data statistically analyzed.

Results: In our study 28 (55%) out of 51 patients in stage II Hypertension had low ABPI as compared to 23 (45%) out of 51 patients in stage I Hypertension. No patients with normal blood pressure had low ABPI. There is significant correlation of stage of hypertension and ABPI (p <0.001). Mean ABPI (0.9102) in stage II hypertensive was low as compared to stage I hypertensive (0.9124) and normotensive subjects (1.0263). ABPI was inversely correlated with lipid profile. The hypertensive subjects with duration of hypertension for more than 5 years, the mean ABPI was significantly lower (0.8773) than those hypertensive subjects who had duration of hypertension less than 5 years (0.9526) (p 0.001).

Conclusions: ABPI proves to be a non-invasive, bed side modality to assess the atherosclerotic risk in hypertensive patients. 


Keywords


ABPI, Atherosclerosis, Hypertension

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References


Katsuyuki Miura, Martha L. Daviglus, Alan R. Dyer, Kiang Liu, Daniel B. Garside, Jeremiah Stamler, Philip Greenland, Relationship of Blood Pressure to 25-Year Mortality Due to Coronary Heart Disease, Cardiovascular Diseases, and All Causes in Young Adult Men. Arch Intern Med. 2001;161:1501-1508.

N Bhasin, D J A Scott Ankle Brachial Pressure Index: identifying cardiovascular risk and improving diagnostic accuracy journal of royal medicine 2007 January; 100(1): 4–5.

Ebrahim S, Smith GD. Systematic review of randomized controlled trials of multiple risk factor interventions for preventing coronary heart disease.BMJ 1997; 314:1666-1674.

Daphne Pereira, Maiya Arun, Kamath Ganesh The Sensitivity and Specificity of Ankle-Brachial Index (ABI) in Diagnosing Peripheral Arterial Disease in Patients with Risk Factors Vol. 1, No. 3 (2007-07 - 2007-09)

Xie X, Ma YT, Yang YN, Li XM, Liu F, Huang D, Fu ZY, Ma X, Chen BD, Huang YAlcohol consumption and ankle-to-brachial index: results from the Cardiovascular Risk Survey PLoS One. 2010 Dec 2;5(12):e15181.

Ogren M, Hedblad B, Jungquist G, Isacsson SO, Lindell SE, Janzon LLow ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study "Men born in 1914", Malmö, Sweden. Eur J Vasc Surg. 1993 Sep;7(5):500-6.

M. Kornitzer M. Dramaix J Sobolskin S. Degre G. De Backer Ankle/Arm Pressure Index in Asymptomatic Middle-Aged Males: An Independent Predictor of Ten-Year Coronary Heart Disease Mortality ANGIOLOGY March 1995 vol. 46 no. 3;211-219.

Murabito JM, Evans JC, Larson MG, Nieto K, Levy D, Wilson PW; Framingham Study : the ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study. Arch Intern Med. 2003 Sep 8;163(16):1939-42.

Albert W. Tsai, Aaron R. Folsom, Wayne D. Rosamond, Daniel W. Jones, Ankle-Brachial Index and 7-Year Ischemic Stroke Incidence The ARIC Study Stroke.2001; 32: 1721-1724 doi:10.1161/01.STR.32.8.1721.

Purroy, B. Coll, M. Oro´E. Seto´. Pin˜ol-Ripoll Predictive value of ankle brachial index in patients with acute ischemic stroke Journal compilation 2009 EFNS European Journal of Neurology.

Ananad Doobey, Soniya Anand. Sensitivity and specificity of ankle brachial index in predicting future of cardiovascular outcome. Arterioscler Thromb vasc bio (AHA) 2005,25 ; 1463-1469 .

Sarah H. Wild, Christopher D. Byrne, Felicity B. Smith, Amanda J. Lee and F. Gerald R. Fowkes, Low Ankle-Brachial Pressure Index Predicts Increased Risk of Cardiovascular Disease Independent of the Metabolic Syndrome and Conventional Cardiovascular Risk Factors in the Edinburgh Artery Study Diabetes Care March 2006 vol. 29 no. 3 637-642.

C.L. Heald, F.G.R. Fowkes, G.D. Murray, J.F. Price Risk of mortality and cardiovascular disease associated with the ankle-brachial index: Systematic review Atherosclerosis Volume 189, Issue 1, November 2006, Pages 61-69.

AB Newman, DS Siscovick, TA Manolio, J Polak, LP Fried, NO Borhani and SK Wolfson Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group Circulation.1993; 88: 837-845.

A.J. Lee, J.F. Price, M.J. Russell, F.B. Smith, M.C.W. van Wijk and F.G.R. Fowkes. Improved Prediction of Fatal Myocardial Infarction Using the Ankle Brachial Index in Addition to Conventional Risk Factors : The Edinburgh Artery Study Circulation 2004, 110:3075-3080.

Raman P G ,Thakur BS, Mathew V Ankle brachial index as a predictor of generalized atherosclerosis. J Assoc Physicians India 2001 Nov;49:1074-7.

Caruana MF, Bradbury AW, Adam DJ The validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice, Eur J Vasc Endovasc Surg. 2005 May;29(5):443-51.

Guo X, Li J, Pang W, Zhao M, Luo Y, Sun Y, Hu D. Sensitivity and specificity of ankle-brachial index for detecting angiographic stenosis of peripheral arteries Circ J. 2008 Apr;72(4):605-10.

Markus A. Busch, Katrin Lutz , Jens-Eric Röhl, Low Ankle-Brachial Index Predicts Cardiovascular Risk After Acute Ischemic Stroke or Transient Ischemic Attack Stroke.2009; 40: 3700-3705.

Sidney C. Smith, Philip Greenland, Scott M. Grundy. Prevention Conference V Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention: Executive Summary. Circulation.2000; 101: 111-116.

Philip Greenland, Jonathan Abrams, Gerard P. Aurigemma, M. Gene Bond, Luther T. Clark, Michael H. Criqui, John R. Crouse, III, Lawrence Friedman, Valentin Fuster, David M. Herrington Prevention Conference V Beyond Secondary Prevention: Identifying the High-Risk Patient for Primary Prevention : Non-invasive Tests of Atherosclerotic Burden : Writing Group III Circulation. 2000;101: e16-e22.