Ankle Systolic Blood Pressure Research Articles

Relationships between ankle blood pressure indices and major adverse cardiovascular events in people with and without type 2 diabetes

BackgroundThe relationship between ankle blood pressure (BP) and cardiovascular disease remains unclear. We examined the relationships between known and new ankle BP indices and major cardiovascular outcomes in people with and without type 2 diabetes.MethodsWe used data from 3 large trials with measurements of ankle systolic BP (SBP), ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). The primary outcome was a composite of cardiovascular mortality, myocardial infarction, hospitalization for heart failure, or stroke. Secondary outcomes included death from cardiovascular causes, total (fatal and non-fatal) myocardial infarction, hospitalization for heart failure, and total stroke.ResultsAmong 42,929 participants (age 65.6 years, females 31.3%, type 2 diabetes 50.1%, 53 countries), the primary outcome occurred in 7230 (16.8%) participants during 5 years of follow-up (19.4% in people with diabetes, 14.3% in those without diabetes). The incidence of the outcome increased with lower ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, multivariable-adjusted hazard ratios (HRs, 95% CI) of the outcome for each lower fourth were 1.05 (0.98–1.12), 1.17 (1.08–1.25), and 1.54 (1.54–1.65) for ankle SBP; HR 1.06 (0.99–1.14), 1.26 (1.17–1.35), and 1.48 (1.38–1.58) for ABI; and HR 1.02 (0.95–1.10), 1.15 (1.07–1.23), and 1.48 (1.38–1.58) for APPD. The largest effect size was noted for ankle SBP (HRs 1.05 [0.90–1.21], 1.21 [1.05–1.40], and 1.93 [1.68–2.22]), and APPD (HRs 1.08 [0.93–1.26], 1.30 [1.12–1.50], and 1.97 [1.72–2.25]) with respect to hospitalization for heart failure, while only a marginal association was observed for stroke. The relationships were similar in people with and without diabetes (all p for interaction > 0.05).ConclusionsInverse and independent associations were observed between ankle BP and cardiovascular events, similarly in people with and without type 2 diabetes. The largest associations were observed for heart failure and the smallest for stroke. Including ankle BP indices in routine clinical assessments may help to identify people at highest risk of cardiovascular outcomes.Graphical abstractAnkle blood pressure indices and incidence of major cardiovascular outcomes. Expanded MACE, a composite of death from cardiovascular causes, myocardial infarction,hospitalization for heart failure, or stroke. BP, blood pressure; CV, cardiovascular; HHF, hospitalization for heart failure; HR, Hazard ratio (for the lowest fourth of blood pressure indice compared to the highest); MACE, major adverse cardiovascular events; MI, myocardial infarction; Total, fatal and non-fatal MI or stroke.

Real-time estimation of blood oxygenation parameters from human foot sole during leg elevation: A preliminary study with diffuse reflectance spectroscopy

This study investigated the applicability of diffuse reflectance spectroscopy (DRS) for real-time and non-invasive measurement of blood oxygenation parameters (BOPs) such as reduced hemoglobin (RHb), oxyhemoglobin (HbO2), and oxygen saturation (SO2) from human foot sole during leg elevation. Seventeen (17) healthy male subjects aged between 21 to 39 years were included in this study. Diffuse reflectance spectra were recorded from measurement sites namely the 5th metatarsal, ball of great joint, calcaneum, and great toe of the human foot sole w.r.t. leg elevation angles such as 00, 150, 300, 450, and 600, respectively. The localized BOPs were derived from the recorded spectra. In addition, blood hemodynamic parameters (BHPs) such as heart rate (HR), SO2, perfusion index (PI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were also measured for each elevating angle. To study and assess the changes in BOPs and BHPs w.r.t. leg elevation, a One-way ANOVA test followed by a Tukey HSD post-hoc test was performed. We observed a statistically significant increase in RHb (p < 0.001) and a decrease in HbO2 (p < 0.001) after 45° of leg elevation, however, there was no statistically significant difference in SO2 (p = 0.74) and HR (p = 0.84) for each measurement site w.r.t. leg elevation, respectively. Furthermore, PI (p < 0.01), ankle SBP (p < 0.001) and DBP (p < 0.001) were decreased w.r.t. leg elevation. The obtained results are in agreement with the literature. The preliminary results suggest that DRS has the potential for real-time estimation of BOPs from the local sites of healthy human foot soles during leg elevation. Thus, it opens the possibility of DRS to monitor and evaluate the diagnosis and treatment of ischemia and edema during leg elevation of patients through BOPs measurement.

Accuracy of oscillometric noninvasive blood pressure at the ankle in the lateral position during general anesthesia

BackgroundThis study aimed to evaluate the accuracy of ankle blood pressure measurements in relation to invasive blood pressure in the lateral position.MethodsThis prospective observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement – noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis.ResultsWe analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval [CI]) of ankle MAP for detecting hypotension was 0.88 (0.83–0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97–100)% and 21 (15–29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79–0.86) with negative and positive predictive values (95% CI) of 95 (92–97)% and 36 (26–46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was − 12 ± 17, 3 ± 12, and − 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively.ConclusionIn patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.

Abstract P531: Contralateral Differences in Ankle Systolic Blood Pressure and Pulse Wave Velocity: Associations With Incident Heart Failure and Mortality

Introduction: Contralateral differences in systolic blood pressure (SBP) are a risk assessment tool and indicative of underlying cardiovascular issues. Most of the available studies focused on brachial blood pressure and its clinical impact. This study evaluated whether interankle SBP differences and contralateral differences in pulse wave velocity (PWV) are associated with incident heart failure (HF) and all-cause and cardiovascular mortality in a community-dwelling sample of older adults. Methods: Sample included 5,077 participants (75.2 ± 5.1 years old) of the Atherosclerosis Risk in Communities (ARIC) study. The OMRON VP-1000 plus was used to measure PWV and blood pressure in the ankles. PWV was assessed between the brachial artery and ankle (baPWV) and heart and ankle (haPWV) on the right and left sides. Cut points for contralateral differences in PWV were set at the 90th percentile in our sample. Outcomes included incident HF (first definite or probable hospitalization for acute decompensated HF), all-cause and cardiovascular mortality (until December 31, 2020). Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Over a mean follow-up of 7.5 ± 2.1 years, incident HF was diagnosed in 457 participants, and 1,275 all-cause and 363 cardiovascular deaths occurred. The prevalence of interankle SBP difference ≥10 and ≥15 mmHg was 24.9% (1,268) and 12.0% (605), respectively. The prevalence of contralateral differences in baPWV (&gt;240 cm/s) and haPWV (&gt;80 cm/s) was 10.1% (513) and 9.1% (464), respectively. Interankle SBP difference ≥10 mmHg (HR 1.13; 95% CI 1.00-1.29), ≥15 mmHg (HR 1.25; 95% CI 1.06-1.48), contralateral difference in baPWV &gt;240 cm/s (HR 1.18; 95% CI 1.00-1.41), and haPWV &gt;80 cm/s (HR 1.21; 95% CI 1.01-1.44) were each independently associated with all-cause mortality after adjustment for demographics, traditional cardiovascular risk factors, and extreme values of ankle-brachial index ≤0.9 or &gt;1.40. Contralateral differences in ankle SBP ≥15 mmHg (HR 1.55; 95% CI 1.16-2.06), and haPWV &gt;80 cm/s (HR 1.40; 95% CI 1.02-1.91) were both independently associated with cardiovascular mortality. Crude analysis revealed that those with contralateral differences in ankle SBP ≥10 and ≥15 mmHg, baPWV &gt;240 cm/s, and haPWV &gt;80 cm/s had a significantly higher risk of HF (p&lt;0.05 for all). However, these HF relationships were no longer statistically significant after adjustment for confounders. Conclusions: Contralateral differences in ankle SBP and PWV were independently associated with all-cause and cardiovascular mortality risk even after accounting for traditional cardiovascular risk factors and the ankle-brachial index. These results underscore the significance of evaluating contralateral differences in ankle SBP and PWV as potential markers of increased mortality risk among older adults.

Arm and ankle blood pressure indices, and peripheral artery disease, and mortality: a cohort study.

Few studies have compared arm and ankle blood pressures (BPs) with regard to peripheral artery disease (PAD) and mortality. These relationships were assessed using data from three large prospective clinical trials. Baseline BP indices included arm systolic BP (SBP), diastolic BP (DBP), pulse pressure (arm SBP minus DBP), ankle SBP, ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). These measurements were categorized into four groups using quartiles. The outcomes were PAD (the first occurrence of either peripheral revascularization or lower-limb amputation for vascular disease), the composite of PAD or death, and all-cause death. Among 40 747 participants without baseline PAD (age 65.6 years, men 68.3%, diabetes 50.2%) from 53 countries, 1071 (2.6%) developed PAD, and 4955 (12.2%) died during 5 years of follow-up. Incident PAD progressively rose with higher arm BP indices and fell with ankle BP indices. The strongest relationships were noted for ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, adjusted hazard ratios (95% confidence interval) for each lower fourth were 1.64 (1.31-2.04), 2.59 (2.10-3.20), and 4.23 (3.44-5.21) for ankle SBP; 1.19 (0.95-1.50), 1.66 (1.34-2.05), and 3.34 (2.75-4.06) for ABI; and 1.41 (1.11-1.78), 2.04 (1.64-2.54), and 3.63 (2.96-4.45) for APPD. Similar patterns were observed for mortality. Ankle BP indices provided the highest c-statistics and classification indices in predicting future PAD beyond established risk factors. Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality.

Abstract 17482: Association of Ankle-Brachial Index with Coronary Artery Calcium Scoring for Coronary Vascular Disease Risk Stratification

Introduction: The Ankle-Brachial Index (ABI) and coronary artery calcium scoring (CACS) are important tools for cardiovascular disease risk stratification. This study aimed to investigate the association between ABI index in combination with CACS for risk stratification of coronary vascular disease. Hypothesis: Given that both the ABI and the Coronary Artery Calcium Scoring are predictors of cardiovascular events, we hypothesize that an association between the Multiethnic Study on Subclinical Atherosclerosis Coronary Artery Calcium Scoring (MESA-CACS) and ABI exists. Methods: A total of 2655 patients (mean age 59±6 years, 72% male, and 87% white) who underwent CACS screening and ABI as part of a primary prevention screening program at the Cleveland Clinic between March 2016 and October 2021 were included in this study. ABI measurements were obtained by dividing the ankle systolic blood pressure by the brachial systolic blood pressure. The 10-year risk score based on MESA-CACS was calculated and categorized into 4 groups (&lt;1%, 1-4.99%, 5-9.99% and ≥10%). ABI was categorized into normal (1-1.4), non-compressible (≥ 1.4) and abnormal (&lt; 1). Results: Among the total of 2655 patients, 164 (6%) had a MESA-CAC score of &lt;1%, 1566 (59%) had a score of 1-4.99%, 501 (19%) had a score of 5-9.99%, and 424 (16%) had a score of ≥10%. The median ABI was 1.17 (range 0.79-1.77) on the left and 1.17 (0.50-1.78) on the right. Tabulating the patients based on their ABI index across the MESA-CACS categories showed no significant difference among the groups with a p-value of 0.830 (Fig 1), with the majority of the patients (&gt; 98% of patients) in all 4 groups having a normal ABI index of 1-1.4. Conclusion: The ABI did not demonstrate a significant association with the MESA-CACS, suggesting its potential use as a synergistic marker for coronary vascular disease risk stratification. Long-term cohort studies are needed to validate this result.

Post-Exercise Ankle–Brachial Index Is Reduced in Healthy, Young Individuals at a Level Indicating Peripheral Artery Disease

In young patients referred for exercise-induced pain in the legs, false positive tests are a potential problem for the post-exercise ankle–brachial index (ABI) test when using the current American Heart Association guidelines for diagnosing peripheral artery disease (PAD). The present study aimed to investigate post-exercise ABI in healthy young people, and to explore whether the current diagnostic criteria for pathological ABI should be revised. Forty-eight volunteers (18–30 years) were included. Resting examinations included ABI and ultrasound of the external iliac artery. Post-exercise examinations after a treadmill load included ABI and ultrasound of the external iliac artery; after 0 min and after 3 min. A total of 60.5% of the participants had a post-exercise decrease in ABI &gt; 20%. A total of 6.5% showed a decrease in ankle systolic blood pressure &gt;30 mmHg. No significant association was observed between a change in blood flow in the external iliac artery and a reduction in ABI post-exercise. Analyses of the ultrasound recordings showed no turbulence in the external iliac artery. According to the results, a 20% decrease in ABI post-exercise seems to be a physiological condition present in young people. We support the need for a reassessment of the criteria for diagnosing PAD.

Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians

Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.

Renal biomarkers reflect overall hypertensive organ damage: “one organ to rule them all”

Abstract Background/Introduction Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognized as an independent risk factor for cardiovascular events. Purpose We hypothesized that there is a relationship between ACR and markers of TOD in never-treated hypertensives. Methods We enrolled 924 consecutive essential hypertensives (mean age 53±12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. Results ACR exhibited significant association with LVMI (r=0.277, p&amp;lt;0.001, Figure), PWV (r=0.277, p&amp;lt;0.001) ABI (r=−0.078, p=0.018) and eGFR (r=−0.100, p=0.002). In further analysis, ACR was associated with TOD as suggested by the 2018 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI&amp;gt;115 g/m2 in men and &amp;gt;95 g/m2 in women), increased PWV (PWV&amp;gt;10m/s), decreased ABI (ABI&amp;lt;0.9) and decreased renal function (eGFR&amp;lt;60ml/min)]. Specifically, ACR exhibited significant association with the number of TOD and this association was independent of age and gender (p&amp;lt;0.05). Conclusions Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD. Funding Acknowledgement Type of funding sources: None. Association between LVMI and ACR

Differential associations of ankle and brachial blood pressures with diabetes and cardiovascular diseases: cross-sectional study

Increased brachial systolic blood-pressure (BP) predicts diabetes (T2DM) but is not fully effective. Value of absolute ankle systolic BP for T2DM compared to brachial systolic BP is not known. Our objectives were to assess independent relationships of ankle-systolic BP with T2DM and cardiovascular disease in Europeans and south Asians. Cross-sectional studies of anonymised data from registered adults (n = 1087) at inner city deprived primary care practices. Study includes 63.85% ethnic minority. Systolic BP of the left and right-brachial, posterior-tibial and dorsalis-pedis-arteries measured using a Doppler probe. Regression models’ factors were age, sex, ethnicity, body mass index (BMI) and waist height ratio (WHtR). Both brachial and ankle systolic-BP increase with diabetes in Europeans and south Asians. We demonstrated that there was a significant positive independent association of ankle BP with diabetes, regardless of age and sex compared to Brachial. There was stronger negative association of ankle blood pressure with cardiovascular disease, after adjustment for BMI, WHtR and ethnicity. Additionally, we found that ankle BP were significantly associated with cardiovascular disease in south Asians more than the Europeans; right posterior tibial. Ankle systolic BPs are superior to brachial BPs to identify risks of Type 2DM and cardiovascular diseases for enhanced patient care.

Endovascular repair of recurrent aortic coarctation with a custom made hourglass shaped stent graft

A 76-year-old male patient with previous open repair resection and end-to-end anastomosis in young adulthood of a congenital coarctation of the descending thoracic aorta was referred to our center for a symptomatic recurrence (A). The patient reported dyspnea and lower extremity fatigue, whereas clinical examination showed weak femoral pulses and a 50 mm Hg gradient between brachial and ankle systolic blood pressure measurements. Medical history was otherwise unremarkable and renal function was normal.

Comparative study of ankle brachial pressure index and blood sugar profile among offspring of diabetic and non-diabetic parents in early detection of peripheral arterial disease

Background: Type 2 diabetes mellitus (T2DM) is a complex disorder which is caused by a composite combination of genetic, epigenetic, and environmental factors. One of the most contributing quantitative risk factors is family history. The prevalence of peripheral arterial disease (PAD) in T2DM ranges from 20% to 30% and the lifetime risk of developing diabetes is up to 40% if either of parents is type 2 diabetic. Aim and Objectives: The aim of the study was to know whether non-diabetic offsprings of diabetic parents having chances of becoming diabetic and to have PAD in future part of life. Material and Methods: Taking all inclusion and exclusion criteria into consideration, 50 offsprings of diagnosed diabetic parents (>5 years) were taken as cases, and 50 healthy age-matched offsprings were taken from non-diabetic parents as controls. A thorough physical and systemic examination were done. After getting informed written consent, anthropometric measurements, FBS, PPBS, HbA1c, were measured. By taking ankle systolic blood pressure (SBP) and brachial SBP, ankle-brachial pressure index (ABPI) was calculated using a hand held vascular Doppler. Statistical analysis was done by Student’s t-test in SPSS software. Results: The mean HbA1c (%) level for controls was 5.68 ± 0.35 and for cases was 5.85 ± 0.44 with a P-value of 0.035 (significant). Similarly mean values for ankle SBP (mm Hg) were 148.4 ± 17.33 in controls and 159.8 ± 23.66 in cases with a P-value 0.0071 (significant). About 32% of controls and 50% of cases showed a non-compressible ABPI (ncABPI) arteries of >1.3, whereas only 2% of cases showed a typical ABPI of PAD, that is,

Variation in four limb blood pressure and central aortic pressure: An observational study on North Indian semi-urban males

Background: Measurement of ankle pressure along with measurement of both arm blood pressure (BP) can be helpful to for calculation of ankle-brachial index (ABI) and detection of early peripheral diseases among the patients. Non-invasive measurement of central aortic pressures is possible as considered as better marker for central hemodynamic situation. Studies on normal subjects are scant. Aim and Objectives: The present study was conducted to evaluate the difference of BP in four limbs obtained from simultaneous recording and evaluate the association with central aortic BP components and peripheral BP components in normal Indian healthy male subjects. Materials and Methods: The study was conducted in the Department of Physiology of Mayo Institute of Medical Sciences, Barabanki, with 25 healthy clinically normal subjects. Four limb BP was recorded and ABI and central aortic pressures were estimated using periscope arterial health and cardiovascular analysis system. Results: Ankle systolic BP (SBP) was significantly high for both sides. Inter-ankle mean arterial pressure difference found to be significantly associated with ABI. Central aortic systolic pressure was found to be lower than the peripheral SBP. Conclusion: Ankle BP measurement to be considered for early detection of peripheral arterial disease and should be performed routinely in hypertension clinics. Central aortic pressure gives a better picture for identifying the hypertensive state of the body.

Continuous Non-Invasive Arterial Pressure Monitoring (ClearSight System) and Ankle Blood Pressure Measurements as Alternatives to Conventional Arm Blood Pressure.

Measuring blood pressure (BP) via a pneumatic cuff placed around the arm has long been the standard method. However, in clinical situations where BP monitoring at the arm is difficult, the ankle is frequently used instead. We compared continuous non-invasive blood pressure (CNBP) measurements obtained at the finger, ankle BP and arm BP in patients undergoing breast cancer surgery. Arm BP, ankle BP (both obtained with a conventional pneumatic cuff) and CNBP measurements were obtained every 2.5 min during surgery. Correlation and Bland–Altman analyses were performed and differences among measurements were analyzed using a linear mixed model. A total of 245 sets of BP measurements were obtained from 10 patients. All systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP) measurements of ankle BP and CNBP were positively correlated with the arm BP measurements (Spearman rho 0.688–0.836, p < 0.001 for each correlation). The difference between CNBP and arm SBP was significantly smaller (least squares mean (95% confidence interval): −6.03 (−11.40, −0.67)) compared to that between ankle and arm SBP (least squares mean (95% CI): −15.32 (−20.69, −9.96), p = 0.019). However, this significant difference was not observed in DBP and MBP (−1.23 vs. 1.75, p = 0.190 and −3.85 vs. −2.63, p = 0.604, respectively). Ankle SBP measurements showed larger differences from arm SBP measurements than did CNBP SBP measurements in patients undergoing breast cancer surgery. CNBP could serve as a useful alternative to ankle BP when standard arm BP measurements cannot be obtained.

Accuracy of noninvasive blood pressure measured at the ankle during cesarean delivery under spinal anesthesia.

In this study, we evaluated the accuracy of oscillometric noninvasive blood pressure (NIBP) measured at the ankle in detecting low arm NIBP during cesarean delivery under spinal anesthesia. In this prospective observational study, a cohort of full-term mothers undergoing elective cesarean delivery under spinal anesthesia was examined. Simultaneous NIBP measurements were obtained from the arm and the ankle. The primary outcome was the accuracy of the ankle NIBP in detecting arm systolic blood pressure (SBP) < 90mmHg. Other outcomes included the accuracy of ankle NIBP in detecting SBP < 80% of the baseline value. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the accuracy of ankle NIBP in detecting low arm NIBP. The Bland-Altman analysis was conducted to evaluate the agreement between values. We analyzed 1729 pairs of readings obtained from 97 mothers. Ankle SBP showed good accuracy in detecting SBP < 90mmHg, with an AUC (95% confidence interval [CI]) of 0.90 (0.89-0.91) and a negative predictive value (NPV) of 99 (98-99%) at a cutoff value of ≤ 103mmHg. Furthermore, ankle SBP showed good accuracy in detecting SBP < 80% of the baseline value, with an AUC (95% CI) of 0.84 (0.82-0.89) and an NPV of 95 (93-96%) at a cutoff value of ≤ 76% of the ankle baseline SBP. The mean bias between the two sites of measurement was - 5.4 ± 15.5, - 2.0 ± 11, and 0.5 ± 12.1mmHg for SBP, diastolic blood pressure, and mean arterial pressure, respectively. In conclusion, ankle NIBP measurement is not interchangeable with arm NIBP measurement. However, ankle NIBP measurement showed good accuracy for ruling out low arm NIBP during a cesarean delivery.Clinical trial rejistration: NCT04199156.

Ambulatory arterial stiffness index in diabetic patients.

Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.

The ankle brachial index in people with and without diabetes: intra-tester reliability

BackgroundThe ankle-brachial index (ABI) is widely used for determining the presence and severity of peripheral arterial disease (PAD), and current guidelines suggest it should be used to monitor possible progression in affected individuals. It is therefore important that the technique demonstrates adequate reliability for repeated measurements. Existing studies suggest that the ABI is reliable in the general population however, there is a lack of evidence for the reliability of the ABI in people with diabetes. The aim of this study was to investigate the intra-tester reliability of the ABI in people with and without diabetes.MethodsEighty-five participants (40 with and 45 without diabetes) underwent ankle and brachial systolic blood pressure measurements by a single clinician during two testing sessions. Intraclass correlation coefficients (ICC), their 95% limits of agreement, standard error of measurement and minimal detectable change were determined.ResultsIntra-tester reliability of the ABI was found to be good (ICC: 0.80), however sub-group analysis of participants with and without diabetes found that ABI was slightly less reliable in people with diabetes (ICC: 0.78) than in those without (ICC: 0.82). The relatively large limits of agreement (− 0.16 to 0.16), standard error of measurement (0.03 overall, 0.04 for the diabetes group), and minimal detectable change (0.08 overall, 0.11 for the diabetes group) suggest that a large change in ABI is required for it to demonstrate a true change rather than the result of measurement variability. The minimal detectable change for the ABI was 0.08 overall, and 0.11 for the diabetes group.ConclusionsThe ABI demonstrated good reliability in all groups analysed. However, the wide limits of agreement and considerable standard error of measurement obtained support the use of multiple methods of vascular assessment for ongoing monitoring of lower limb vascular status.

Feasibility study to evaluate cycloidal vibration therapy for the symptomatic treatment of intermittent claudication

IntroductionIntermittent claudication (IC) is the most common symptom of peripheral arterial disease. Previous research has suggested that cycloidal vibration therapy (CVT) may induce angiogenesis and improvements in circulation. The objective of this feasibility study was to explore trial design and acceptability of the protocol to provide data to estimate the parameters required to design a definitive randomised control trial. This feasibility study specifically aimed to assess recruitment rate; attendance rates at baseline and follow-up; and safety, tolerability, and compliance with therapy device and additionally, to consider the potential efficacy of CVT as a novel treatment for intermittent claudication.MethodsPatients with intermittent claudication (IC) were recruited and CVT was applied at home for 30 min twice a day for a period of 12 weeks. Primary outcomes were pain-free walking time (PFWT) and maximum walking time (MWT) after 12 weeks of treatment. Secondary outcomes included the ankle-brachial index and ankle systolic blood pressure. Participants were assessed during active therapy phase at baseline, week 4, week 8, and week 12.ResultsThirty-four participants with IC were recruited: 30 (88%) male and 4 (12%) female. The rate of recruitment was 2.4 participants per month from a standard-size district general hospital. No participants left the study during the activity therapy stage, and no participant failed to attend their follow-up appointment. The general compliance with CVT was high. No participants dropped out during the treatment phase. The mean age of all participants was 68 years (IQR 60–75 years). Substantive improvements were seen in a comparison of differences in times to PFWT and MWT, in ABPI, and in systolic leg pressure in the treated leg. There was no evidence of a substantive difference from baseline in systolic leg pressure in the untreated leg. There were no immediate or delated treatment safety concerns of documented adverse effects with the treatment, all patients completed the required 12-week course indicated a high degree of patient acceptability.ConclusionThe statistically significant and substantive improvements from baseline after 12 weeks observed in PFWT and MWT in participants experiencing IC are comparable to improvements seen from other treatment options such as supervised exercise as reported by Stewart et al. (N Engl J Med 347:1941–1951, 2002). The substantive improvement in systolic leg pressure in the treated leg and the concurrent absence of a substantive change in systolic leg pressure in the untreated leg over the same period suggests a causative effect.This study has provided novel information relating to the number of potential eligible participants for a further research trial and potential association between CVT and improved symptoms. Additionally, it has established that CVT treatment is highly acceptable, as indicated by no participant drop-out in the treatment phase, and may potentially offer an alternative treatment option for patients experiencing IC. Furthermore, this study has assessed the variability of the primary outcome measure which provides vital information needed to calculate sample sizes for any future studies.In conclusion, this study has established the feasibility of using CVT to improve patients’ symptoms of IC and provides essential information which will contribute to the design of future research investigating whether the improvements seen are directly related to CVT.

Effects of acute footbath before and after glucose ingestion on arterial stiffness.

The present study investigated the acute effect of a footbath on increases in arterial stiffness after glucose ingestion in healthy young women. Nine healthy young women (aged 18.4 ± 0.2 years; mean ± SE) completed three trials in random order. They started a footbath before 75-g oral glucose ingestion, a footbath after 75-g oral glucose ingestion and no footbath (control) trials. Aortic (carotid–femoral) and leg (femoral–ankle) pulse wave velocity, the carotid augmentation index, carotid, brachial and ankle blood pressure, heart rate, blood glucose levels, insulin levels and sublingual temperature were measured before (baseline) and at 15, 30, 60 and 90 min after the 75-g oral glucose ingestion. Aortic pulse wave velocity and brachial systolic blood pressure did not change from baseline to after the 75-g oral glucose ingestion in all trials. Leg pulse wave velocity and ankle systolic blood pressure were increased from baseline to after the 75-g oral glucose ingestion in the footbath after glucose ingestion and control trials, but not in the footbath before glucose ingestion trial. These results suggest that a footbath effectively suppresses the increase in leg arterial stiffness after glucose ingestion when implemented before glucose ingestion.

Post-exercise ankle blood pressure and ankle to brachial index after heavy load bicycle exercise

The American Heart Association (AHA) recommendations for diagnosing peripheral artery disease (PAD) after exercise are a decrease >20% of ankle brachial index (ABI) or >30mm Hg of ankle systolic blood pressure (ASBP) from resting values. We evaluated ABI and ASBP values during incremental maximal exercise in physically active and asymptomatic patients. Patients (n=726) underwent incremental bicycle tests with pre- and post-exercise recording of all four limbs arterial pressures simultaneously. Univariate and multivariate analyses were performed to define the correlation between post-exercise ABI with various clinical factors, including age. Thereafter, the population was divided into groups of age: less than 40 (G<40), from 40 to 44 (G40/44) from 45 to 49 (G45/49), from 50 to 54 (G50/54), from 55 to 59 (G55/59), from 60 to 64 (G60/64), and 65 and above (G≥65) years. Results are mean±SD. * is two-tailed P<.05 for ANOVA with Dunnett's post-hoc test from G40. Changes from rest in ASBP were -3±22 (G<40), -2±20 (G40/44), 4±22* (G45/49), 10±25* (G50/54), 18±21* (G55/59), 23±27* (G60/64), and 16±22* (G≥65) mm Hg. Decreases from rest in ABI were 32±9 (G<40), 33±9 (G40/44), 29±8 (G45/49), 27±10* (G50/54), 24±7* (G55/59), 22±12* (G60/64), and 21±12* (G≥65) % of resting ABI. Maximal incremental exercise results in ABI and ASBP changes are mostly dependent on age. The AHA limits for post-exercise ABI are inadequate following maximal incremental bicycle testing. Future studies detecting PAD in active patients should account for the effect of age.