Decreased Ankle/Arm Blood Pressure Index and Mortality in Elderly Women

OBJECTIVE: To evaluate the relationship of the ankle/arm blood pressure index to short-term mortality in women 65 years of age or older. DESIGN: Prospective cohort study with average follow-up of 4.3 years. SETTING: Rural community near Pittsburgh, Pa. PARTICIPANTS: A total of 1492 white women 65 years of age or older, living in the community and ambulatory without the help of another person. OUTCOME MEASURES: All-cause and cause-specific mortality. RESULTS: The ankle/arm index (the systolic pressure in the posterior tibial artery divided by that in the brachial artery) was measured in 1986 through 1988 and found to be 0.9 or less in 82 (5.5%) of the women, 67 of whom reported no symptoms of claudication. Comparing women with an index of 0.9 or less with those with an index greater than 0.9, the relative risk for all-cause mortality 4 years later (after adjustment for age, smoking, and other risk factors) was 3.1 (95% confidence interval Cl, 1.7 to 5.5); for heart disease, 3.7 (95% Cl, 1.2 to 11.6); for cardiovascular diseases, 4.0 (95% Cl, 1.3 to 8.5); for cancer, 3.3 (95% Cl, 1.3 to 8.5); and for all other causes, 1.1 (95% Cl, 0.1 to 9.2). Similar levels of risk were found after excluding women with symptoms of claudication and/or a history of cardiovascular disease at baseline. CONCLUSIONS: Healthy, older women with an ankle/arm index of 0.9 or less are at high risk of death and therefore may be considered for aggressive therapy to modify cardiovascular risk factors.