To the Editor.
—The articles by Vogt et al1 and Newman et al2 and the accompanying editorial by Applegate3 cogently describe the potential usefulness of ankle/arm blood pressure ratios in the assessment of cardiovascular risk. However, none of the authors mention an additional important use for arm/leg blood pressure ratios—that is, in the assessment for adult coarctation of the aorta.Culbertson et al4 demonstrated lower femoral blood pressures compared with brachial pressures in a series of patients with coarctation. In nine patients for whom complete data were available, the calculated femoral to brachial blood pressure index averaged 0.64. Two of the patients were over 40 years old. Liberthson et al5 noted that 10% of cases of coarction were diagnosed in patients over the age of 40 years. Thus, coarctation is associated with a low AAI and can occur in patients over the age of 40
Lief PD. Ankle/Arm Blood Pressure Index. JAMA. 1994;271(1):26. doi:10.1001/jama.1994.03510250042026