Hypertension and high ankle brachial index: the overlooked combination

Area of Science:

• Cardiovascular Medicine
• Hypertension Management
• Vascular Health

Background:

• Current hypertension management guidelines focus on low ankle-brachial index (ABI) values (<0.9) for assessing organ damage.
• High ABI (≥1.3) is associated with increased cardiovascular risk, yet lacks specific management recommendations.
• This study investigates the prognostic significance of high ABI in hypertensive individuals.

Purpose of the Study:

• To determine the association between high ankle-brachial index (ABI) values and all-cause mortality in hypertensive patients.
• To evaluate the relationship of high ABI with cardiovascular outcomes, including heart failure, myocardial infarction, and stroke.

Main Methods:

• A large cohort of hypertensive patients aged 35-85 years was established using anonymized clinical records from the Catalan Primary Care (SIDIAP) database.
• Patients with pre-existing cardiovascular disease, diabetes, or chronic kidney disease were excluded.
• Cox proportional hazards models were employed to analyze the association of ABI categories with mortality and cardiovascular events.

Main Results:

• High ABI (≥1.3) was significantly associated with an increased risk of all-cause mortality (HR 1.44; 95% CI 1.10-1.88).
• Mortality risk for high ABI was comparable to intermediate ABI values (0.9 to <1.1) and lower than low ABI values (<0.9).
• A trend towards increased heart failure risk was observed with high ABI (HR 1.34; 95% CI 0.95-1.91), while associations with myocardial infarction and stroke were not significant.

Conclusions:

• Hypertensive patients with high ankle-brachial index (ABI) values exhibit an elevated risk of all-cause mortality.
• The prognostic implications of high ABI should be considered in clinical practice for hypertension management and patient counseling.
• Further research may clarify the specific cardiovascular risks associated with high ABI in this population.