Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 7, Number 5, October 2016, pages 161-166

Pulse Pressure and Upstroke Time Are Useful Parameters for the Diagnosis of Peripheral Artery Disease in Patients With Normal Ankle Brachial Index

Figure 1. Receiver operating characteristic curve of pulse pressure (PP), %mean atrial pressure (%MAP) and upstroke time (UT) for detection of PAD. The mean area under the ROC curve and 95% CI for PP, %MAP and UT were 0.628 (0.569 - 0.687), 0.650 (0.593 - 0.706) and 0.676 (0.615 - 0.737), respectively. And the cut-off level of PP, %MAP and UT were 53.0 mm Hg, 38.0% and 173.0 ms, respectively.

**Table 1.** Patient Characteristics Showing No Differences Between Both Groups
	PAD group (n = 136)	Non-PAD group (n = 240)	P value
BMI: body mass index. Continuous data are expressed as the mean ± standard deviation. P values were determined using the Student’s t-test.
Age (years)	70.3 ± 9.7	70.4 ± 11.7	0.510
Male/female	100/36	166/74	0.174
Height (cm)	161.5 ± 9.0	160.0 ± 9.4	0.069
Weight (kg)	61.1 ± 11.6	61.4 ± 12.2	0.589
BMI (kg/m²)	23.3 ± 3.7	23.9 ± 3.9	0.918
Lower limb symptoms (%)	30.1 ± 46.1	24.6 ± 43.1	0.121

Table 1. Patient Characteristics Showing No Differences Between Both Groups

PAD group (n = 136)

Non-PAD group (n = 240)

P value

BMI: body mass index. Continuous data are expressed as the mean ± standard deviation. P values were determined using the Student’s t-test.

Age (years)

70.3 ± 9.7

70.4 ± 11.7

0.510

Male/female

100/36

166/74

0.174

Height (cm)

161.5 ± 9.0

160.0 ± 9.4

0.069

Weight (kg)

61.1 ± 11.6

61.4 ± 12.2

0.589

BMI (kg/m²)

23.3 ± 3.7

23.9 ± 3.9

0.918

Lower limb symptoms (%)

30.1 ± 46.1

24.6 ± 43.1

0.121

**Table 2.** Cardiovascular Risk Factors in Patients in the PAD Group
	PAD group (n = 136)	Non-PAD group (n = 240)	P value
RAS-I: renin-angiotensin-aldosterone system inhibitor; HMG-CoA inhibitor: 3-hydroxy-3-methylglutaryl-coenzyme A inhibitor. Continuous data are expressed as the mean ± standard deviation. P values were determined using the Student’s t-test.
Hypertension, n (%)	96 (70.8)	155 (64.6)	0.118
Dyslipidemia, n (%)	55 (40.4)	80 (33.3)	0.084
Diabetes mellitus, n (%)	49 (36.0)	49 (20.4)	< 0.001
Hemodialysis, n (%)	17 (12.5)	19 (7.9)	0.074
RAS-I, n (%)	42 (30.9)	63 (26.3)	0.169
Calcium channel blocker, n (%)	59 (43.4)	78 (32.5)	0.018
β-blocker, n (%)	42 (30.9)	63 (26.3)	0.169
Antihypertensive medications, n (%)	90 (66.2)	150 (62.5)	0.239
Number of antihypertensive medications	1.48 ± 1.37	1.24 ± 1.27	0.043
HMG-CoA inhibitor, n (%)	49 (36.0)	59 (24.6)	0.009
Lipid lowering medications, n (%)	52 (38.2)	72 (30.0)	0.052
Glucose lowering medications, n (%)	45 (33.1)	46 (19.2)	0.001

Table 2. Cardiovascular Risk Factors in Patients in the PAD Group

PAD group (n = 136)

Non-PAD group (n = 240)

P value

RAS-I: renin-angiotensin-aldosterone system inhibitor; HMG-CoA inhibitor: 3-hydroxy-3-methylglutaryl-coenzyme A inhibitor. Continuous data are expressed as the mean ± standard deviation. P values were determined using the Student’s t-test.

Hypertension, n (%)

96 (70.8)

155 (64.6)

0.118

Dyslipidemia, n (%)

55 (40.4)

80 (33.3)

0.084

Diabetes mellitus, n (%)

49 (36.0)

49 (20.4)

< 0.001

Hemodialysis, n (%)

17 (12.5)

19 (7.9)

0.074

RAS-I, n (%)

42 (30.9)

63 (26.3)

0.169

Calcium channel blocker, n (%)

59 (43.4)

78 (32.5)

0.018

β-blocker, n (%)

42 (30.9)

63 (26.3)

0.169

Antihypertensive medications, n (%)

90 (66.2)

150 (62.5)

0.239

Number of antihypertensive medications

1.48 ± 1.37

1.24 ± 1.27

0.043

HMG-CoA inhibitor, n (%)

49 (36.0)

59 (24.6)

0.009

Lipid lowering medications, n (%)

52 (38.2)

72 (30.0)

0.052

Glucose lowering medications, n (%)

45 (33.1)

46 (19.2)

0.001

**Table 3.** Blood Pressures in the PAD Group Were Higher Than Those in the Non-PAD Group
	PAD group (n = 136)	Non-PAD group (n = 240)	P value
ABI: ankle brachial index; CAVI: cardio ankle vascular index; %MAP: %mean arterial pressure; UT: upstroke time; SBP: systolic blood pressure; DBP: diastolic blood pressure; mBP: mean blood pressure; PP: pulse pressure. Continuous data were expressed as mean ± standard deviation. P values were determined using the Student’s t-test.
ABI	1.03 ± 0.08	1.08 ± 0.10	1.000
CAVI	9.40 ± 1.99	8.93 ± 1.46	0.005
%MAP (%)	44.5 ± 21.7	38.2 ± 5.4	< 0.001
UT (ms)	170.7 ± 45.9	147.9 ± 29.3	< 0.001
SBP (mm Hg)	144.2 ± 21.5	139.3 ± 20.0	0.014
DBP (mm Hg)	83.8 ± 13.2	85.3 ± 13.2	0.863
mBP (mm Hg)	109.8 ± 19.6	106.0 ± 16.3	0.024
PP (mm Hg)	60.4 ± 15.0	54.0 ± 13.1	< 0.001
Heart rate (bpm)	70.2 ± 13.4	70.6 ± 12.6	0.597

Table 3. Blood Pressures in the PAD Group Were Higher Than Those in the Non-PAD Group

PAD group (n = 136)

Non-PAD group (n = 240)

P value

ABI: ankle brachial index; CAVI: cardio ankle vascular index; %MAP: %mean arterial pressure; UT: upstroke time; SBP: systolic blood pressure; DBP: diastolic blood pressure; mBP: mean blood pressure; PP: pulse pressure. Continuous data were expressed as mean ± standard deviation. P values were determined using the Student’s t-test.

ABI

1.03 ± 0.08

1.08 ± 0.10

1.000

CAVI

9.40 ± 1.99

8.93 ± 1.46

0.005

%MAP (%)

44.5 ± 21.7

38.2 ± 5.4

< 0.001

UT (ms)

170.7 ± 45.9

147.9 ± 29.3

< 0.001

SBP (mm Hg)

144.2 ± 21.5

139.3 ± 20.0

0.014

DBP (mm Hg)

83.8 ± 13.2

85.3 ± 13.2

0.863

mBP (mm Hg)

109.8 ± 19.6

106.0 ± 16.3

0.024

PP (mm Hg)

60.4 ± 15.0

54.0 ± 13.1

< 0.001

Heart rate (bpm)

70.2 ± 13.4

70.6 ± 12.6

0.597

**Table 4.** Univariate and Multivariate Analysis for Prediction of PAD
	Univariate analysis	Multivariate analysis
BMI: body mass index; ABI: ankle brachial index; CAVI: cardio ankle vascular index; SBP: systolic blood pressure; DBP: diastolic blood pressure; mBP: mean blood pressure; PP: pulse pressure; %MAP: %mean arterial pressure; UT: upstroke time; HR: hazard ratio; CI: confidence interval. Univariate analysis was performed by applying Cox proportional hazard models for continuous variables. Factors found to be significant upon univariate analysis were included in a multivariate analysis.
Age	0.89	0.58 - 1.36	0.586
Men	1.31	0.83 - 2.09	0.250
BMI	0.88	0.56 - 1.37	0.558
ABI	0.33	0.21 - 0.52	< 0.001	0.49	0.30 - 0.81	0.006
CAVI	2.72	1.58 - 4.67	< 0.001	1.64	0.89 - 3.03	0.111
SBP	1.01	1.00 - 1.02	0.030	1.18	0.57 - 2.43	0.660
DBP	0.62	0.40 - 0.94	0.026	0.52	0.28 - 0.97	0.039
mBP	1.93	1.16 - 3.21	0.012	2.30	1.22 - 4.37	0.010
PP	1.03	1.02 - 1.05	< 0.001	1.30	0.69 - 2.46	0.041
Heart rate	1.32	0.75 - 2.32	0.335
%MAP	2.82	1.77 - 4.50	< 0.001	1.77	1.05 - 2.98	0.031
UT	5.33	3.28 - 8.66	< 0.001	3.44	2.03 - 5.83	< 0.001

Table 4. Univariate and Multivariate Analysis for Prediction of PAD

Univariate analysis

Multivariate analysis

95% CI

P value

95% CI

P value

BMI: body mass index; ABI: ankle brachial index; CAVI: cardio ankle vascular index; SBP: systolic blood pressure; DBP: diastolic blood pressure; mBP: mean blood pressure; PP: pulse pressure; %MAP: %mean arterial pressure; UT: upstroke time; HR: hazard ratio; CI: confidence interval. Univariate analysis was performed by applying Cox proportional hazard models for continuous variables. Factors found to be significant upon univariate analysis were included in a multivariate analysis.

Age

0.89

0.58 - 1.36

0.586

Men

1.31

0.83 - 2.09

0.250

BMI

0.88

0.56 - 1.37

0.558

ABI

0.33

0.21 - 0.52

< 0.001

0.49

0.30 - 0.81

0.006

CAVI

2.72

1.58 - 4.67

< 0.001

1.64

0.89 - 3.03

0.111

SBP

1.01

1.00 - 1.02

0.030

1.18

0.57 - 2.43

0.660

DBP

0.62

0.40 - 0.94

0.026

0.52

0.28 - 0.97

0.039

mBP

1.93

1.16 - 3.21

0.012

2.30

1.22 - 4.37

0.010

1.03

1.02 - 1.05

< 0.001

1.30

0.69 - 2.46

0.041

Heart rate

1.32

0.75 - 2.32

0.335

%MAP

2.82

1.77 - 4.50

< 0.001

1.77

1.05 - 2.98

0.031

5.33

3.28 - 8.66

< 0.001

3.44

2.03 - 5.83

< 0.001