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Shi Y, Hu L, Li M, Ding C, Zhou W, Wang T, Zhu L, Bao H, Cheng X. The ankle-brachial index and risk of incident stroke in Chinese hypertensive population without atrial fibrillation: A cross-sectional study. J Clin Hypertens (Greenwich) 2020; 23:114-121. [PMID: 33200878 PMCID: PMC8029689 DOI: 10.1111/jch.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022]
Abstract
We aimed to evaluate the relation of the ankle–brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27‐96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82‐0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (<1.05) would significantly increase the odds of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old. A generalized additive model and a smooth curve fitting showed that there existed an L‐shaped association between ABI and the prevalence of stroke. Our results suggest that an L‐shaped association between ABI and the prevalence of stroke was found in general hypertensive patients, with a turning point at about 1.05. Compared with higher ABI value, lower ABI value (<1.05) would significantly increase the prevalence of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minghui Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Congcong Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Hao Z, Yang C, Tao W, Liu M. Prognostic implications of the Ankle Brachial Index in patients with acute ischemic stroke: A meta-analysis. Expert Rev Neurother 2016; 16:351-8. [PMID: 26786967 DOI: 10.1586/14737175.2016.1142875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The ankle brachial index (ABI) is recognized as a marker of atherosclerotic disease. The detection of ABI may improve the risk stratification. METHODS We systematically searched Pubmed and Embase (from the earliest date to October 2015) for studies evaluating the prognostic value of ABI in patients with acute ischemic stroke. Stroke or cardiovascular events, mortality and functional outcomes were analyzed. RESULTS Seventeen studies, containing 9404 patients, were included. The mean age of participants in each study ranged from 64 to 79 years. The prevalence of low ABI varied from 7.4% to 40.5%. In this quantitative analysis, we found that low ABI increased the risk of composite outcomes (myocardial infarction or stroke or mortality), disability and mortality. CONCLUSION The detection of ABI may help to identify high-risk patients for secondary stroke prevention.
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Affiliation(s)
- Zilong Hao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Chunsong Yang
- b Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children , Sichuan University , Chengdu , China
| | - Wendan Tao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Ming Liu
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
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Guo H, Sun F, Dong L, Chang H, Gu X, Zhang H, Sheng L, Tian Y. The Association of Four-Limb Blood Pressure with History of Stroke in Chinese Adults: A Cross-Sectional Study. PLoS One 2015; 10:e0139925. [PMID: 26452268 PMCID: PMC4599855 DOI: 10.1371/journal.pone.0139925] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/19/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We investigated the association of ankle-brachial blood pressure index (ABI), interarm blood pressure (BP) difference and interankle BP difference, obtained by simultaneous four-limb BP measurement, with history of stroke in a Chinese adult population. METHODS This cross-sectional study included 1485 participants aged ≥35 years in the framework of the China Hypertension Survey. We performed simultaneous four-limb BP measurement using oscillometric devices with the participants in the supine position and calculated ABI and interarm/interankle BP differences between the 4 limbs. Logistic regression analysis was used to estimate the association of these BP parameters and other factors with a history of stroke. RESULTS In univariate analyses, participants with ABI <0.9, interarm BP difference ≥15 mmHg, and interankle BP difference ≥10 mmHg had a higher prevalence of stroke than those without (p < 0.0001, p = 0.0152, p = 0.002, respectively). Multiple logistic regression analyses suggested, ABI <0.9 was independently associated with a history of stroke after adjustment for interarm BP difference ≥15 mmHg, interankle BP difference ≥10 mmHg, and traditional risk factors for stroke (p = 0.001). An interankle BP difference ≥10 mmHg was associated with prior stroke after the two variables of hypertension and ABI were removed from the logistic regression model (p = 0.0142). Net reclassification improvement analysis showed that inclusion of interankle BP difference ≥10 mmHg to the independent risk factors (age, family history of stroke, hypertension, and ABI) improved net reclassification by 11.92%. CONCLUSION ABI <0.9 is an independent risk factor for stroke prevalence in Chinese adults and it just detected a small propotion of paticipants. The addition of interankle BP difference ≥10 mmHg to the independent risk factors for stroke may improve the prediction of stroke.
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Affiliation(s)
- Hong Guo
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
- Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, Harbin Medical University, Harbin 150081, P.R. China
- Heilongjiang Academy of Medical Sciences, Harbin Medical University, Harbin 150081, P.R. China
| | - Fengyu Sun
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Lihang Dong
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Huiying Chang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Xingbo Gu
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Haiyu Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Lijiang Sheng
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
| | - Ye Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, P.R. China
- Department of Pathophysiology, Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Harbin 150081, P.R. China
- Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, Harbin Medical University, Harbin 150081, P.R. China
- Heilongjiang Academy of Medical Sciences, Harbin Medical University, Harbin 150081, P.R. China
- * E-mail:
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