Brachial and ankle pulse pressure measurements, particularly left brachial pulse pressure, are independently associated with severe coronary artery stenosis severity, with sex-specific differences observed in ankle pulse pressure predictive performance.
Key Findings
Results
Pulse pressure values at all four measurement sites were significantly higher in the severe coronary stenosis group compared with the mild stenosis group.
All four measurement sites assessed: left brachial, right brachial, left ankle, and right ankle pulse pressures
Comparisons made between severe stenosis group (T3) and mild stenosis group (T1)
All comparisons reached statistical significance at P < 0.001
Study enrolled 218 patients from a tertiary hospital in China between 1 July 2023 and 31 January 2024
Results
Left brachial pulse pressure (LPP) was independently associated with severe coronary stenosis in multivariate logistic regression analysis.
OR: 0.048 (95% CI: 0.010–0.227, P = 0.01)
Association was identified as independent after multivariate adjustment
Multiple logistic regression was the primary analytical method employed
Results
Left brachial pulse pressure demonstrated favorable predictive performance for severe coronary stenosis in both sexes via ROC analysis.
AUC value of 0.862 in men for left brachial pulse pressure
AUC value of 0.854 in women for left brachial pulse pressure
Receiver operating characteristic (ROC) curve analysis was used to assess predictive performance
Results
Sex-specific differences were observed in the predictive performance of ankle pulse pressure for severe coronary stenosis.
Right ankle pulse pressure showed numerically higher AUC values in men (AUC = 0.847)
Left ankle pulse pressure showed numerically higher AUC values in women (AUC = 0.842)
These differences were described as numerically higher, suggesting the comparisons were not formally tested for statistical significance between sexes
Methods
The study design was a cross-sectional analysis in a single tertiary hospital in China using standardized measurements of brachial and ankle pulse pressures alongside coronary artery stenosis assessment.
Total sample size was 218 patients
Data collection period: 1 July 2023 to 31 January 2024
Measures included brachial artery pulse pressure, ankle artery pulse pressure, degree of coronary artery stenosis, and number of major vascular lesion branches
Patients were stratified into tertiles (T1, T2, T3) based on coronary stenosis severity
What This Means
This research suggests that simple blood pressure measurements taken at the arm (brachial) and ankle can reflect how severely the coronary arteries — the vessels that supply the heart — are narrowed. In a study of 218 Chinese adults at a single hospital, researchers measured the difference between the highest and lowest blood pressure readings (called pulse pressure) at four sites on the body and compared these values to how severely each patient's coronary arteries were blocked. They found that patients with the most severe blockages had consistently higher pulse pressures at all four sites compared to patients with mild blockages.
The left arm pulse pressure was the strongest and most independent predictor of severe coronary artery narrowing, performing well for both men and women (with AUC values above 0.85, where 1.0 represents perfect prediction). Interestingly, the study also found that ankle pulse pressure predictions differed by sex: the right ankle measurement worked slightly better for men, while the left ankle measurement worked slightly better for women. These findings suggest that where you measure pulse pressure on the body may matter differently depending on a patient's sex.
This research suggests that routinely measuring pulse pressure at the arm and ankle — which are relatively simple, non-invasive procedures — could help clinicians identify patients who may be at higher risk for severe coronary artery disease. This could potentially enable earlier or more targeted interventions. However, as a cross-sectional study conducted at a single hospital with a modest sample size, further research in larger and more diverse populations would be needed to confirm and extend these findings.
Song J, Wang H, Mao Y, Zheng L, Chen L, Yang C, et al.. (2026). Association of Brachial-Ankle pulse pressure with coronary artery stenosis severity: A sex-specific cross-sectional study in Chinese adults.. PloS one. https://doi.org/10.1371/journal.pone.0350269