![]() ![]() No special precautions are needed afterward. The ankle-brachial index test should take only a few minutes. The device uses sound waves to produce images and allows the pulse in the ankle arteries to be heard after the cuff is deflated. ![]() This is done using an inflatable cuff and a hand-held ultrasound device that's pressed on the skin. A care provider measures your blood pressure in both arms and both ankles. Typically, you lie on a table on your back. You likely will be asked to rest for 5 to 30 minutes before the test. This allows the provider doing the ankle-brachial index test to easily place a blood pressure cuff on an ankle and upper arm. The test is painless and similar to having blood pressure taken in a routine medical visit. No special preparations are needed for an ankle-brachial index test. Severe leg pain might require a different imaging test of the arteries in the legs. But this discomfort is temporary and should stop when the air is released from the cuff. Thus, it is important nowadays to indicate in the various cohorts the number of subjects by age class and to obtain a long-term follow-up of subjects >70 years of age.įinally, the population of this article 1 has 2 major particularities that might explain some results: the mean age at entry in the cohort was 39 years, and at this age, it is well accepted that diastolic BP is the BP component that is more closely related to CV risk and the follow-up is particularly long (33 years), so that a regression dilution bias should limit the ability of comparing the various BP components for CV risk prediction.The blood pressure cuffs might cause pain on the arm and leg while they inflate. In such conditions, there is little chance that PP could be attributed exclusively to increased arterial stiffness. 3 When hypertension began to be considered as a “disease” to treat, most of the cohorts of the literature were studied on the basis of young hypertensive populations, as in the Chicago cohort. The Framingham Study has indicated that the predictive value of PP is observed only at >60 years of age. Third, several groups have extensively shown that SBP and PP increase markedly with age, mostly for PP. This was done only in a single article of the literature. This problem is poorly discussed in the literature, but the “principal component analysis” is one of the most available statistical methodologies to perform in such conditions. Second, all of the statistical evaluations on SBP and PP have in common the same difficulty, ie, the problem of colinearity of the different components of BP measurements. To our knowledge, nowadays, no guideline in the literature indicates such very simple and basic definitions of CV physiology. ![]() Furthermore, the understanding of PP requires us to admit that BP propagates at a given velocity (pulse wave velocity) along the totality of the arterial tree, involves the presence of wave reflections, and is characterized by the presence of aortic-brachial SBP and PP amplification. Indeed, PP is, by definition, a risk factor observed both in normotensive and hypertensive subjects. The former depends largely on the (arbitrary) definition of hypertension, whereas the latter involves risk in the totality of a given population. This finding supports the usual approach of major current guidelines but also raises major questions related to SBP and PP (here measured exclusively at the site of the brachial artery).įirst, the classification into SBP or PP reflects, in fact, a particular approach in the clinical management of CV risk. The study by Mosley et al 1 shows in a large population that, in the predictive value of cardiovascular (CV) risk, pulse pressure (PP) is less effective than systolic (SBP) or diastolic blood pressure (BP). Customer Service and Ordering Information. ![]()
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