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July 28, 1993

Morbidity and Mortality in Hypertensive Adults With a Low Ankle/Arm Blood Pressure Index

Author Affiliations

From the Department of Medicine, Medical College of Pennsylvania, Allegheny Campus (Dr Newman), and the Department of Epidemiology, University of Pittsburgh (Drs Newman, Sutton-Tyrrell, Vogt, and Kuller), Pittsburgh, Pa.

JAMA. 1993;270(4):487-489. doi:10.1001/jama.1993.03510040091035

Objective.  —To evaluate the relationship between the ankle/arm blood pressure index (AAI, the ratio of ankle to arm systolic blood pressure, a measure of peripheral arterial disease) and short-term cardiovascular morbidity and mortality in older adults with systolic hypertension.

Design.  —Prospective cohort study, 1- to 2-year follow-up (mean, 16 months).

Setting.  —Eleven of 16 field centers from the Systolic Hypertension in the Elderly Program.

Participants.  —1537 older men and women with systolic hypertension.

Main Outcome Measures.  —All-cause mortality, coronary heart disease (CHD) mortality, cardiovascular disease (CVD) mortality, and CHD and CVD morbidity and mortality.

Results.  —The AAI was measured at the 1989-1990 clinic examination and was 0.9 or less in 25.5% of 1537 participants. A low AAI was associated with most major CHD and CVD risk factors. In those with a low AAI (≤0.9) compared with those with an AAI of more than 0.9, age- and sex-adjusted relative risks for mortality end points at follow-up were as follows: total mortality, 3.8 (95% confidence interval [CI], 2.1 to 6.9); CHD mortality, 3.24 (95% CI, 1.4 to 7.5); and CVD mortality, 3.7 (95% CI, 1.8 to 7.7). For CVD morbidity and mortality, the age- and sex-adjusted relative risk was 2.5 (95% CI, 1.5 to 4.3). After adjustment for baseline CVD and other cardiovascular risk factors, the relative risk for total mortality was 4.1 (95% CI, 2.0 to 8.3) and for CVD morbidity and mortality, 2.4 (95% CI, 1.3 to 4.4).Results were similar when participants with clinical CVD at baseline were excluded.

Conclusion.  —A low AAI appears to be an important predictor of morbidity and mortality among older adults with systolic hypertension.(JAMA. 1993;270:487-489)