Abstract
ObjectiveWe investigated the association of ankle-brachial blood pressure index (ABI), interarm blood pressure (BP) difference and interankle BP difference, obtained by simultaneous four-limb BP measurement, with history of stroke in a Chinese adult population.MethodsThis cross-sectional study included 1485 participants aged ≥35 years in the framework of the China Hypertension Survey. We performed simultaneous four-limb BP measurement using oscillometric devices with the participants in the supine position and calculated ABI and interarm/interankle BP differences between the 4 limbs. Logistic regression analysis was used to estimate the association of these BP parameters and other factors with a history of stroke.ResultsIn univariate analyses, participants with ABI <0.9, interarm BP difference ≥15 mmHg, and interankle BP difference ≥10 mmHg had a higher prevalence of stroke than those without (p < 0.0001, p = 0.0152, p = 0.002, respectively). Multiple logistic regression analyses suggested, ABI <0.9 was independently associated with a history of stroke after adjustment for interarm BP difference ≥15 mmHg, interankle BP difference ≥10 mmHg, and traditional risk factors for stroke (p = 0.001). An interankle BP difference ≥10 mmHg was associated with prior stroke after the two variables of hypertension and ABI were removed from the logistic regression model (p = 0.0142). Net reclassification improvement analysis showed that inclusion of interankle BP difference ≥10 mmHg to the independent risk factors (age, family history of stroke, hypertension, and ABI) improved net reclassification by 11.92%.ConclusionABI <0.9 is an independent risk factor for stroke prevalence in Chinese adults and it just detected a small propotion of paticipants. The addition of interankle BP difference ≥10 mmHg to the independent risk factors for stroke may improve the prediction of stroke.
Highlights
Stroke is the leading cause of death and long-term disability in Chinese adults [1]
An interankle blood pressure (BP) difference 10 mmHg was associated with prior stroke after the two variables of hypertension and ankle-brachial blood pressure index (ABI) were removed from the logistic regression model (p = 0.0142)
Net reclassification improvement analysis showed that inclusion of interankle BP difference 10 mmHg to the independent risk factors improved net reclassification by 11.92%
Summary
Stroke is the leading cause of death and long-term disability in Chinese adults [1]. The total stroke incidence rate has declined over the past two decades in the USA, but in contrast has increased annually by 6.5% in China [2, 3]. When peripheral artery disease (PAD) is present in arteries in the upper extremities, the reduced BP in the diseased arm may possibly delay the diagnosis of hypertension, and lead to delays in the implementation of interventions to decrease the risk of stroke. The epidemiology of BP ratios and differences obtained from simultaneous BP measurements has not been well characterized, and the relationship between abnormal four-limb BP parameters determined from simultaneous BP measurements and stroke has received little attention. It is important to evaluate the relevance of these BP-derived indexes to stroke, as the identification of individuals with abnormal BP is both simple and quick, and may afford the opportunity to reduce aggressively the risk of stroke with preventive therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
