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Table of Contents   
LETTER TO THE EDITOR  
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 207-208
High pulse pressure and potential utility in screening for peripheral artery disease


1 Bangkhae, Bangkok, Thailand
2 Hainan Medical University, Hainan, China; Joseph Ayo Babalola University, Nigeria; University of Niš, Niš, Serbia; Dr. DY Patil Medical University, Pune, Maharashtra, India

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Date of Web Publication3-May-2016
 

How to cite this article:
Wiwanitkit S, Wiwanitkit V. High pulse pressure and potential utility in screening for peripheral artery disease. Ann Trop Med Public Health 2016;9:207-8

How to cite this URL:
Wiwanitkit S, Wiwanitkit V. High pulse pressure and potential utility in screening for peripheral artery disease. Ann Trop Med Public Health [serial online] 2016 [cited 2019 Dec 9];9:207-8. Available from: http://www.atmph.org/text.asp?2016/9/3/207/179131
Dear Sir,

Peripheral artery disease has become the emerging public health problem around the world. Screening is warranted to early diagnosis. There is a recent interesting report on “high pulse pressure (PP), low ankle-brachial index (ABI), and potential utility in screening for peripheral artery disease”.[1] Del Brutto et al. mentioned that “PP calculation may be a simple tool to detect candidates for ABI testing.”[1] However, there is a big consideration on the measurement of blood pressure and the calculation of PP. First, the PP is usually calculated based on other parameters. Hence, the error can be easily seen. Error is common in basic blood pressure measurement and this can contribute to error in the PP calculation. As noted by Smulyan et al. and Safar et al., “the inaccuracy of the auscultatory systolic (SBP) and diastolic (DBP) measurements are necessarily transmitted to the arithmetically calculated mean (MBP) and PP.”[2] In addition, if different personnel perform the measurement, variability can be expected.[3] Also, the circadian variability of PP has to be kept in mind. A single measurement and calculation might be unreliable. The underlying physiological and pathological background can also affect the PP. It is seen that race, body mass index (BMI), as well as underlying metabolic disorders (such as diabetes mellitus) significantly affect PP.[4] Blacher et al. recently noted that PP was highly variable and did not mean any cardiovascular risk.[5] The use of the new proposed technique compared to the standard ABI testing should be completely assessed. At least the diagnostic property (sensitivity, specificity, and accuracy) needs to be evaluated.

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   References Top

1.
Del Brutto OH, Mera RM, Sedler MJ, Gruen JA, Phelan KJ, Cusick EH, et al. The relationship between high pulse pressure and low ankle-brachial index. Potential utility in screening for peripheral artery disease in population-based studies. High Blood Press Cardiovasc Prev 2015;22:275-80.   Back to cited text no. 1
    
2.
Smulyan H, Safar ME. Blood pressure measurement: Retrospective and prospective views. Am J Hypertens 2011;24:628-34.  Back to cited text no. 2
    
3.
Odagiri T, Morita T, Yamauchi T, Imai K, Tei Y, Inoue S. Convenient measurement of systolic pressure: The reliability and validity of manual radial pulse pressure measurement. J Palliat Med 2014;17:1226-30.   Back to cited text no. 3
    
4.
Butler KR Jr, Penman AD, Minor DS, Mosley TH Jr. Determinants of pulse pressure and annual rates of change in the Atherosclerosis Risk in Communities study. J Hypertens 2015;33:2463-70.  Back to cited text no. 4
    
5.
Blacher J, Staessen JA, Girerd X, Gasowski J, Thijs L, Liu L, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000;160:1085-9.  Back to cited text no. 5
    

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Correspondence Address:
Somsri Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.179131

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