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Year : 2013  |  Volume : 10  |  Issue : 1  |  Page : 1-2

The role of ankle brachial index in the diagnosis of peripheral artery disease in hypertensive subjects in a Nigerian Health Centre

Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication21-Sep-2013

Correspondence Address:
Kamilu M Karaye
Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, PO Box 4445, Kano
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-7969.118560

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How to cite this article:
Karaye KM. The role of ankle brachial index in the diagnosis of peripheral artery disease in hypertensive subjects in a Nigerian Health Centre. Nig J Cardiol 2013;10:1-2

How to cite this URL:
Karaye KM. The role of ankle brachial index in the diagnosis of peripheral artery disease in hypertensive subjects in a Nigerian Health Centre. Nig J Cardiol [serial online] 2013 [cited 2023 May 31];10:1-2. Available from: https://www.nigjcardiol.org/text.asp?2013/10/1/1/118560

The epidemiology of Lower Extremity Arterial Disease (LEAD) has been investigated in many Countries including Nigeria, where it was previously reported to be very rare. Yakubu et al. had earlier reported that over a period of 10 years, a total of 320 limb amputations were performed on adults at the Ahmadu Bello University Hospital, Nigeria, but there was no case of peripheral vascular disease in the patients other than diabetic ulcers. [1] More recently, lower extremity peripheral artery disease (LEAD) was also found to be absent among hypertensive subjects at very high absolute cardiovascular risk. [2] These two studies relied exclusively on the symptoms and signs of LEAD, which are grossly inadequate for its diagnosis.

The primary non-invasive test for the diagnosis of LEAD is the ankle-brachial index (ABI). In healthy persons, the ABI is >1.0. Usually an ABI <0.90 is used to define LEAD. The actual sensitivity and specificity have been estimated, respectively, at 79% and 96%. [3] The level of ABI also correlates with LEAD severity, with high-risk of amputation when the ABI is <0.50. An ABI change of >0.15 is generally required to consider worsening of limb perfusion over time, or improving after revascularization. [4] In addition, the ABI is a strong marker of cardiovascular diseases (CVD), and is predictive of cardiovascular events and mortality. Low ABI values (<0.90) are predictive of atherosclerosis, such as coronary and carotid arterial diseases. [5]

In the study by Umuerri et al., ABI was used in a cross-sectional study to assess the prevalence of LEAD and its association with some CVD risk factors. [6] Patients were recruited consecutively, while excluding those with pedal edema, regardless of the presence or absence of intermittent claudication (IC). They got a prevalence of 41.8% using ABI among 153 hypertensive subjects, while a history of IC was obtained in only 7.8% of the subjects, and combining ABI with IC did not improve on the diagnostic sensitivity of the former. In this study, there was no significant statistical relationship between LEAD and its key traditional risk factors, namely increased age, smoking, male sex, and dyslipidemia. The use of ABI to assess for LEAD is novel in Nigerian settings, which makes the Umuerri study commendable. Ikem et al. had previously reported using ABI to assess for LEAD in diabetic subjects in Ile-Ife, Nigeria, which is another commendable effort. [7]

The Umueri study has raised an important question: is atherosclerosis as common in Nigerian hypertensive patients as suggested by the study, given the high prevalence of LEAD? Unfortunately, the study has not provided us with enough details to answer the question because of the lack of some important information, including:

  1. No detailed clinical information such as findings on examination of the cardiovascular system, including auscultation of the femoral arteries at the groin level; palpation of the femoral, popliteal, dorsalis pedis, and posterior tibial sites; examination of the skin for the color, temperature, and integrity of the skin including calf hair loss. This is because beyond their diagnostic importance, clinical signs could have a prognostic value. [8]
  2. Electrocardiogram, serum creatinine and urinalysis were not carried out to screen for ischemic heart disease and kidney disease, which are important associated clinical conditions that can worsen prognosis.
  3. No matched control group, without which the odds ratio of having LEAD in the presence of hypertension cannot be estimated.
Overall, it could be said that the contribution of the Umuerri study to our understanding of the morbidity of Nigerian hypertensive subjects is not very clear. However, the study is among the first to use a novel tool (ABI) to assess for LEAD among hypertensive subjects in Nigeria.

  References Top

1.Yakubu A, Muhammad I, Mabogunje OA. Major limb amputation in adults, Zaria, Nigeria. J R Coll Surg Edinb 1996;41:102-4.  Back to cited text no. 1
2.Karaye KM, Okeahialam BN, Wali SS. Cardiovascular risk factors in Nigerians with systemic hypertension. Niger J Med 2007;16:119-24.  Back to cited text no. 2
3.Lijmer JG, Hunink MG, van den Dungen JJ, Loonstra J, Smit AJ. ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol 1996;22:391-8.  Back to cited text no. 3
4.Baker JD, Dix DE. Variability of Doppler ankle pressures with arterial occlusive disease: An evaluation of ankle index and brachial-ankle pressure gradient. Surgery 1981;89:134-7.  Back to cited text no. 4
5.Fowkes FG, Price JF, Stewart MC, Butcher I, Leng GC, Pell AC, et al. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: A randomized controlled trial. JAMA 2010;303:841-8.  Back to cited text no. 5
6.Martha UE, Andrew E, Osemwingie OA. Hypertension and lower extremity peripheral artery disease: An overlooked association. Nigerian Journal of Cardiology 2013;10:26-30.  Back to cited text no. 6
7.Ikem R, Ikem I, Adebayo O, Soyoye D. An assessment of peripheral vascular disease in patients with diabetic foot ulcer. Foot (Edinb) 2010;20:114-7.  Back to cited text no. 7
8.European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011;32:2851-906.  Back to cited text no. 8


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