Comparison of reactive hyperemia and treadmill tests in the evaluation of peripheral vascular disease

The systolic ankle pressure response to thigh cuff occlusion (reactive hyperemia test) was compared with a similar measurement after treadmill exercise in 48 limbs of 24 normal volunteers. The reactive hyperemia test was then performed on 26 legs in 16 patients with clinical evidence of arterial disease of the leg and abnormal treadmill tests (mean decrease 39 +/- 24 percent). No decrease in pressure occurred in normal subjects after exercise. All control subjects demonstrated a decrease in pressure after thigh cuff occlusion (34 +/- 7.9 percent). The percent pressure decrease during reactive hyperemia in the abnormal group was significantly lower (49.7 +/- 19 percent; p less than 0.001). There was a high correlation between the percent decrease in pressure during reactive hyperemia and the decrease after exercise in the claudicants (r = 0.69; p less than 0.001). However, the percent pressure decrease in 13 of the 26 abnormal patients fell within 2 standard deviations of the reactive hyperemia control group mean. The range of the pressure decreases in these 13 patients, 16 to 48 percent, was shared by 47 of the 48 normal subjects. The findings in this study are inconsistent with those in previously published reports and suggest that reactive hyperemia testing cannot be used interchangeably with the treadmill exercise test.