Abstract
Peripheral arterial disease (PAD) increases with age and ankle-brachial index (ABI) ≤ 0.9 is a noninvasive marker of PAD. The purpose of this study was to identify risk factors related to a low ABI in the elderly using two different methods of ABI calculation (traditional and modified definition using lower instead of higher ankle pressure). A cross-sectional study was carried out with 65 hypertensive patients aged 65 years or older. PAD was present in 18% of individuals by current ABI definition and in 32% by modified method. Diabetes, cardiovascular diseases, metabolic syndrome, higher levels of systolic blood pressure and pulse pressure, elevated risk by Framingham Risk Score (FRS), and a higher number of total and antihypertensive drugs in use were associated with low ABI by both definitions. Smoking and LDL-cholesterol were associated with low ABI only by the modified definition. Low ABI by the modified definition detected 9 new cases of PAD but cardiovascular risk had not been considered high in 3 patients when calculated by FRS. In conclusion, given that a simple modification of ABI calculation would be able to identify more patients at high risk, it should be considered for cardiovascular risk prediction in all elderly hypertensive outpatients.
Highlights
The number of elderly individuals has been progressively increased in the last decades, and it is expected to reach 21% of the world population by 2025 [1]
peripheral arterial disease (PAD) increases with age [3, 4] and can be assessed by ankle-brachial index (ABI), a simple and noninvasive test, indicated by the ratio of ankle to brachial systolic blood pressure
Several studies have reported that ABI ≤ 0.9 is associated with an increased risk of death, total cardiovascular disease (CVD), coronary heart disease (CHD), congestive heart failure, stroke, functional decline, and dementia [5,6,7,8,9,10,11,12,13,14]
Summary
The number of elderly individuals has been progressively increased in the last decades, and it is expected to reach 21% of the world population by 2025 [1]. It is very important to identify a subset of high-risk aged patients that should receive a more aggressive treatment. Many strategies have been developed for this purpose, including the screening for peripheral arterial disease (PAD). PAD increases with age [3, 4] and can be assessed by ankle-brachial index (ABI), a simple and noninvasive test, indicated by the ratio of ankle to brachial systolic blood pressure. A low ABI is predictive of target organ damage in hypertension and should be incorporated into routine cardiovascular screening of hypertensive patients [15,16,17]
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