I am a 55 yo male who last Feb had CABG for 95% blockage of LAD and first lateral. Since I have been a heavy exerciser for 30 years and whose "standard" risk factors appear to be minimal, I have spent a lot of time investigating what I might change to prevent a recurrance the problem. Have found homocysteine to be high and am on folic acid in addition to Pravachol, aspirin, and Altace.
Prior to discovery of the blockage, I was aware that I had "white coat" hypertension (140/90) and exercise induced hypertension with BP reaching 220/110 at maximal exercise. With 5 mg daily Altace, resting BP is low at about 110/65.
I have read that peripheral artery disease may be another predictor of CAD and its presence may be indicated by brachial bp being significantly lower than the radial bp. I find that my pressure at the ankle is significantly higher than the arm, by 20 to 30 points. Does this mean that the ankle pressure is my system's true pressure and needs further control? I have checked this numerous times on different days being careful to keep the ankle level with the heart. I am using an automatic home bp monitor, but it seems quite consistent getting the measurement in both locations and compares well to a standard cuff on the arm. Since I have been a serious runner and cyclist for years, my legs muscles are quite well developed relative to my puny arms. Could this be a factor? Thank you for your comments.
Normally your ankle bressure should be higher then that taken in your arm. The ratio is determined by the pressure in the ankle dived by the arm pressure. Normal values are a ratio > 0.9.
A few things: If your ratio is above 1.3 it may indicate calcified non compressible vessels and should be further evaluated professionally. Also, the cuff you are using is most likely specifically designed for arm pressures only and may not give accurate measurements, especially if your leg muscle build is significane. It is a bedside test and can be performed by your physician, especially if you are having any symptoms.
In the absence of syndromes, the treatment of PVD is really pretty similar to what you are doing. Aggressive physical training, anti platelet and lipid control, and tight control of your blood pressure.
For now I would use your arm pressure for blood pressure titration.
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