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Measurement of the ankle brachial index with a non-mercury sphygmomanometer in diabetic patients: a concordance study

Magdalena Bundó1*, Magali Urrea2, Laura Muñoz-Ortíz2, Carmen Pérez3, Judit Llussà4, Rosa Forés5, María Teresa Alzamora5 and Pere Torán26

Author Affiliations

1 Primary Health Care Centre Ronda Prim, Catalan Health Institute, Camí del Mig 36, (4th floor), Mataró, Barcelona, 08330, Spain

2 Primary Health Care Research Support Unit Metropolitana Nord, IDIAP Jordi Gol, Catalan Health Institute, Carrer Major 49-53 (1st floor), Santa Coloma de Gramanet, 08921, Spain

3 Primary Health Care Centre Llefià, Catalan Health Institute, Carretera Antigua de Valencia s/n, Badalona, Spain

4 Primary Health Care Centre Sant Roc, Catalan Health Institute, C/ Velez Rubio s/n, Badalona, 08918, Spain

5 Primary Health Care Centre Riu Nord-Riu Sud, Catalan Health Institute, c/ Major 49 Sta. Coloma de Gramenet, Barcelona, 08921, Spain

6 Primary Health Care Centre Gatassa , Catalan Health Institute, Camí del Mig 36 (3rd floor), Mataró, 08303, Spain

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BMC Cardiovascular Disorders 2013, 13:15  doi:10.1186/1471-2261-13-15

Published: 8 March 2013



The removal of mercury sphygmomanometers from health centers requires the validation of other instruments to measure blood pressure in the limbs to calculate the ankle-brachial index (ABI).


Descriptive cross-sectional study of agreement between two measurement methods in type 2 diabetes patients from three urban primary healthcare centres in the Barcelonès Nord i Maresme area (Catalonia, Spain).

ABI was determined with Doppler and mercury sphygmomanometer and Doppler and the “hybrid” sphygmomanometer OMRON HEM-907 model. Agreement was evaluated using the weighted kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using the mercury sphygmomanometer as the gold standard.


211 patients were included, from these, 421 limbs were available for study. The mean age of the participants was 67 years (SD = 10), 51.7% were women.

The index of agreement between ABI measured with a mercury sphygmomanometer and with the OMRON HEM-907 blood pressure monitor was good (weighted kappa index = 0.68; CI 95%: [0.55–0.79]) and improved when the ABI cut-off value was set at ≤0.70 (weighted kappa index = 0.92; CI 95%: [0.81–1.00]). Sensitivity and specificity were 77.5% and 98.2%, respectively. PPV was 83.8% and NPV was 97.3%. With the ABI cut-off value ≤0.70, sensitivity and specificity increased to 85.7% and 100%, respectively, PPV to 100% and NPV to 99.4%.


The combination of a Doppler device with the hybrid sphygmomanometer is a simple and reliable method to measure ABI showing that hybrid sphygmomanometer is a good alternative to the use of mercury sphygmomanometers.

Ankle brachial blood pressure index; Peripheral arterial disease; Blood pressure; Type 2 diabetes mellitus; Doppler; Sensitivity and specificity