Blood Pressure Measurements in Patients With Takayasu Arteritis: A Work of Caution

doi:10.1016/j.athoracsur.2011.09.017

The Annals of Thoracic Surgery

Volume 93, Issue 4, April 2012, Pages 1299-1301

https://doi.org/10.1016/j.athoracsur.2011.09.017 Get rights and content

Takayasu arteritis is a large vessel vasculitis among young women that affects the aorta and its branches. Disease-related subclavian or brachial obstructions can lead to hypotensive brachial blood pressure values. By contrast, arterial hypertension is also frequent in this disease, possibly unrecognized in case of solitary brachial blood pressure measurement. We present the case of a 28-year-old woman with cerebral hypoperfusion related to Takayasu arteritis. Despite “pseudo-hypotensive” brachial blood pressure values of 70 mm Hg, Doppler measurement of the ankle revealed a systolic pressure of 220 mm Hg. In Takayasu vasculitis, additional ankle pressure measurement may represent the true cardiac load and blood pressure.

Section snippets

Comment

Takayasu arteritis is a rare inflammatory vascular disease affecting the aorta and its branches, with an annual incidence of 0.4 to 1 cases per million [1, 6]. Carotid and subclavian involvement is common, but only one case report has described a combination of subclavian steal syndrome and syncope in this disease [7].

As mentioned above, hypertension is frequent in this disease. Nevertheless, when the subclavian arteries are affected, brachial measurement of arterial pressure alone is

References (8)

K. Ishikawa
Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy
J Am Coll Cardiol
(1988)
C.M. Weyand et al.
Medium- and large-vessel vasculitis
N Engl J Med
(2003)
M. Canyigit et al.
Imaging characteristics of Takayasu arteritis
Cardiovasc Intervent Radiol
(2007)
H. Sikaroodi et al.
Stroke as the first manifestation of Takayasu arteritis
Acta Neurol Belg
(2007)

There are more references available in the full text version of this article.

Cited by (7)

The variability of ankle-arm blood pressure difference and ankle-brachial index in treated hypertensive patients
2014, Journal of the American Society of Hypertension
Citation Excerpt :
Meanwhile, the reproducibility of ABI is influenced by some factors, such as limb exercise19 As the An–a difference on SBP and DBP remained at 18–19 and 0–1 mm Hg levels in the treated hypertensive patients, these values may be used as references for arm BP when only ankle BP could be taken.9–12,20 However, these values for supine BP may not be used in other conditions; for example, when BP is taken in the sitting position.
The purpose of this study was to investigate whether ankle–arm blood pressure (BP) difference (An–a) and ankle–brachial index (ABI) are consistent in treated hypertensive patients with obvious BP variation. This study enrolled 414 hypertensive patients (200 males; mean age, 61.3 ± 13.3 years) admitted to our hospital. BP of four limbs was simultaneously measured using four automatic BP measurement devices on the day of admission, and three and six day after admission. The An-a differences on systolic BP (SBP), diastolic BP (DBP), mean artery pressure (MAP), and pulse pressure (PP) in both sides were calculated, respectively. The relative decrease amplitude (RDA) of BP was calculated using the formula: RDA = (BP1 − BPn)/BP1. The ABI of the right side was calculated. From the first to the third measurement, arm SBP and DBP levels of both arms significantly decreased (right arm: SBP: 163.7 ± 18.4, 147.7 ± 15.3 vs. 135.4 ± 11.7 mm Hg; P < .05; DBP: 86.6 ± 13.4, 79.9 ± 11.6 vs. 74.5 ± 9.6 mm Hg; P < .05); at the same time, the ankle SBP (right ankle: 182.1 ± 22.1, 147.7 ± 15.3 vs. 153.4 ± 16.6 mm Hg; P < .05) and DBP (84.8 ± 13.4, 79.9 ± 11.6 vs. 75.8 ± 9.8 mm Hg; P < .05) of both sides also significantly decreased. The mean An–a of three measurements of both sides was consistent at the levels of about 20 mm Hg on SBP and PP, 7 mm Hg on MAP, and 0 mm Hg on DBP. However, sABI gradually increased from the first to the third measurement.In treated hypertensive patients, the An–a differences on SBP, DBP, PP, and MAP are generally consistent, but sABI is associated with underlying SBP levels.
Cardiac involvement in adult patients with autoimmune inflammatory rheumatic diseases
2023, Cardiologia Hungarica
Contemporary Challenges of Acute Ischemic Stroke in Takayasu Arteritis
2020, Stroke
Measurement of blood pressure in the leg—a statement on behalf of the British and Irish Hypertension Society
2020, Journal of Human Hypertension
Measurement of blood pressure in humans: A scientific statement from the american heart association
2019, Hypertension
Defining the relationship between arm and leg blood pressure readings: A systematic review and meta-analysis
2019, Journal of Hypertension

View all citing articles on Scopus

View full text

Case reportBlood Pressure Measurements in Patients With Takayasu Arteritis: A Work of Caution

Section snippets

Comment

J Am Coll Cardiol

Medium- and large-vessel vasculitis

N Engl J Med

Imaging characteristics of Takayasu arteritis

Cardiovasc Intervent Radiol

Stroke as the first manifestation of Takayasu arteritis

Acta Neurol Belg

Case report
Blood Pressure Measurements in Patients With Takayasu Arteritis: A Work of Caution