Related Experiment Video
Updated: Jan 16, 2026
Measuring the Carotid to Femoral Pulse Wave Velocity Cf-PWV to Evaluate Arterial Stiffness
Published on: May 3, 2018
Is the Ankle Brachial Pressure Index an Independent Predictor for Cardiovascular Morbidity and Death in the
Sarah Jane Messeder1, Emily Salt2, Coral Pepper3
1Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK; Leicester Vascular Institute, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK.
Objective:
This study aimed to assess whether the ankle brachial pressure index (ABPI) is independently associated with cardiovascular morbidity and mortality in the asymptomatic general population.
Data Sources:
Ovid MEDLINE, Embase, CINAHL, and Cochrane databases.
Review Methods:
Studies assessing ABPI in a general population with > 30 days follow up were included. A random effects meta-analysis was completed following PRISMA guidelines (PROSPERO: CRD42022383573). Study quality was assessed using the Newcastle-Ottawa Scale, and certainty was assessed through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Outcomes included major cardiovascular events, cardiovascular death, coronary events, cerebrovascular events, and all cause death.
Results:
Twenty-five studies from 23 cohorts were included (20 prospective, four retrospective, and one propensity matched), representing 181 598 individuals. An ABPI < 0.9 was statistically significantly associated with higher cardiovascular mortality (hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.70 - 2.44, p < .001; GRADE, low certainty), major cardiovascular events (HR 1.74, 95% CI 1.56 - 1.94, p < .001; GRADE, very low certainty), coronary events (HR 2.80, 95% CI 2.11 - 3.70, p < .001; GRADE, low certainty), cerebrovascular events (HR 1.75, 95% CI 1.34 - 2.30, p < .001; GRADE, low certainty), and all cause mortality (HR 1.90, 95% CI 1.71 - 2.10, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was statistically significantly associated with higher cardiovascular mortality (HR 2.39, 95% CI 2.02 - 2.83, p < .001; GRADE, low certainty) and all cause mortality (HR 1.92, 95% CI 1.54 - 2.39, p < .001; GRADE, very low certainty) compared with a normal ABPI. An ABPI > 1.3 was not statistically significant for major cardiovascular events (HR 1.07, 95% CI 0.74 - 1.55, p = .70; GRADE, low certainty) or cerebrovascular events (HR 1.80, 95% CI 0.91 - 3.58, p = .090; GRADE, very low certainty).
Conclusion:
An abnormal ABPI is associated with higher cardiovascular and all cause mortality rates. Randomised evidence is needed to assess the cost effectiveness, efficacy, and benefits of screening.
More Related Videos
Related Concept Videos
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:23Assessment of blood pressure in brachial artery(two-step method)
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.