Population Health Research Institute, McMaster University, 237 Barton St. E, Hamilton, ON, Canada L8L 2X2.
INSERM, BMC, U1034, Université de Bordeaux, Avenue de Magellan, 33604 Pessac, France.
Eur Heart J. 2024 May 21;45(19):1738-1749. doi: 10.1093/eurheartj/ehae087.
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.
很少有研究比较手臂和脚踝血压（BP）与外周动脉疾病（PAD）和死亡率之间的关系。本研究使用来自三项大型前瞻性临床试验的数据评估了这些关系。
基线 BP 指标包括手臂收缩压（SBP）、舒张压（DBP）、脉压（手臂 SBP 减去 DBP）、脚踝 SBP、踝肱指数（ABI，脚踝 SBP 除以手臂 SBP）和踝脉搏压差（APPD，脚踝 SBP 减去手臂脉搏压）。这些测量值使用四分位数分为四组。结果是 PAD（首次发生外周血运重建或下肢血管疾病截肢）、PAD 或死亡的复合终点以及全因死亡。
在来自 53 个国家的 40747 名无基线 PAD（年龄 65.6 岁，男性 68.3%，糖尿病 50.2%）的参与者中，1071 人（2.6%）发生了 PAD，4955 人（12.2%）在 5 年的随访期间死亡。随着手臂 BP 指数的升高，PAD 的发生率逐渐升高，而脚踝 BP 指数则逐渐降低。脚踝 BP 指数与 PAD 发生率的关系最强。与脚踝 BP 指数处于最高四分位数的人相比，每个较低四分位数的调整后的危险比（95%置信区间）分别为 1.64（1.31-2.04）、2.59（2.10-3.20）和 4.23（3.44-5.21）；脚踝 SBP；1.19（0.95-1.50）、1.66（1.34-2.05）和 3.34（2.75-4.06）；ABI；1.41（1.11-1.78）、2.04（1.64-2.54）和 3.63（2.96-4.45）；APPD。在预测死亡率方面也观察到类似的模式。脚踝 BP 指数在预测未来 PAD 方面提供了最高的 C 统计量和分类指数，超过了既定的危险因素。
脚踝 BP 指数（包括脚踝 SBP 和 APPD）是预测 PAD 和死亡率的最佳指标。
