Background and Aims 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. Methods 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. Results 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. Conclusions Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality.

中文翻译：

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手臂和脚踝血压指数、外周动脉疾病和死亡率：一项队列研究

背景和目的 很少有研究比较手臂和脚踝血压 (BP) 与外周动脉疾病 (PAD) 和死亡率的关系。这些关系是使用三项大型前瞻性临床试验的数据进行评估的。方法 基线血压指数包括手臂收缩压 (SBP)、舒张压 (DBP)、脉压（手臂 SBP 减去 DBP）、踝部 SBP、踝臂指数（ABI，踝部 SBP 除以手臂 SBP）和踝脉压差值（APPD、踝关节 SBP 减去手臂脉压）。使用四分位数将这些测量结果分为四组。结果是 PAD（首次发生外周血运重建或因血管疾病下肢截肢）、PAD 或死亡以及全因死亡的复合结果。结果 来自 53 个国家的 40 747 名基线没有 PAD 的参与者（年龄 65.6 岁，男性 68.3%，糖尿病 50.2%）中，1071 名（2.6%）患有 PAD，4955 名（12.2%）在 5 年随访期间死亡。事件 PAD 随着手臂血压指数的升高而逐渐上升，随着脚踝血压指数的升高而逐渐下降。脚踝血压指数的关系最强。与踝关节血压指数处于最高第四位的人相比，踝关节每个较低第四位的调整后风险比（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）收缩压；ABI 为 1.19 (0.95–1.50)、1.66 (1.34–2.05) 和 3.34 (2.75–4.06)；APPD 为 1.41 (1.11–1.78)、2.04 (1.64–2.54) 和 3.63 (2.96–4.45)。死亡率也观察到类似的模式。踝关节血压指数提供了最高的 c 统计数据和分类指数，可预测未来 PAD 超出既定风险因素的情况。结论 踝关节血压指数（包括踝关节 SBP 和 APPD）最能预测 PAD 和死亡率。