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January 5, 1994

Ankle/Arm Blood Pressure Index-Reply

Author Affiliations

Allegheny General Hospital
University of Pittsburgh Pittsburgh, Pa

JAMA. 1994;271(1):26-27. doi:10.1001/jama.1994.03510250042027

In Reply.  —We were pleased to hear that Dr Lerman is measuring ankle/arm blood pressure in his office. We used a Doppler because it is standard in vascular laboratories. The oscillometric technique may not be sensitive enough to detect pressure in diseased vessels.1 This could easily be tested by comparing techniques. Portable Doppler equipment to measure arterial disease in the legs is available, but we found that rapid sequential measurements with a hand-held Doppler and standard cuffs to be the least expensive technique. The key to measurement is a slow release of pressure and a steady hand.Dr Lief points out an important cause of a low AAI. Coarctation would be exceedingly rare in the populations we studied. In many hypertensive older adults, the low AAI is often the only easily observed evidence of diffuse vascular disease. Thus, atherosclerosis is still the most likely diagnosis. Limited data on those

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