Blood pressure in legs should be same as in arms



DEAR DR. DONOHUE: In your article on peripheral vascular disease, you suggested taking leg blood pressure. I did, and the readings frighten me. My left leg has a pressure of 174/127; my right leg, 157/122. My arm blood pressures are 108/63 on the right and 115/74 on the left. My husband's right leg pressure is 157/88. The blood pressure cuff was so tight on my ankles that it hurt when I pumped it up.

Dr. Donohue

I am overweight but normally run a low blood pressure. What's up with the leg blood pressures? -- R.J.

ANSWER: Leg blood pressure should be about the same as arm blood pressure. Comparing the two systolic pressures is called the ankle-brachial index. ("Brachial" is the Latin word for "arm.") The normal index is 0.9 to 1.3. If the leg pressure is much lower at the ankle than in the arm, that's a strong indication that there's obstruction in a leg artery. The index will be less than 0.9. If the index is 0.5, that's an indication of severe blockage. The index is a reliable test for peripheral vascular disease, now more commonly called peripheral arterial disease.

You can't get a reliable ankle pressure the same way you get the arm pressure, listening through a stethoscope or reading the values on an ordinary commercial blood pressure device. You need a continuous wave Doppler to record ankle pressure. Many doctors' offices have this gadget. You're not getting reliable pressure with your home blood pressure unit. The Doppler unit is positioned over the posterior tibial artery (behind the bony projection on the inner side of the ankle) or over the dorsalis pedis artery on the top of the foot.

You can, however, get a rough idea of the pressure in those arteries if you can feel a strong pulse in both. The hallmark sign of peripheral artery disease is pain in the buttock, thigh or calf when a person walks. He or she can almost predict with great accuracy the exact distance at which the pain arises. Stopping to rest gets rid of the pain. This sign is called intermittent claudication.

The booklet on peripheral vascular (arterial) disease explains it in greater detail. Readers can obtain a copy by writing: Dr. Donohue -- No. 109, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: You suggested using Drixoral for post nasal drip. We can't find it in any pharmacy. Is it still made? -- M.B. and many, many others

ANSWER: No, it's not still made. The original manufacturer was bought by another drug company that stopped its production. It's still listed as a marketed product in the latest edition (2012) of my drug manual. It contained an antihistamine and a drying agent, pseudoephedrine. Zyrtec D is a comparable substitute. For that matter, a plain antihistamine, like Benadryl, taken at night, works fine.

DEAR DR. DONOHUE: You recently had an article on COPD, chronic obstructive pulmonary disease. Almost one year ago I was diagnosed with pulmonary fibrosis. My recent six-month checkup showed that the fibrosis has not gotten worse. Please provide an article on pulmonary fibrosis. -- J.M.

ANSWER: "Fibrosis" here indicates that strands of scarlike tissue have formed in the lungs. Those strands interfere with inhaled oxygen making its way into the blood. Typical pulmonary fibrosis symptoms are breathlessness when active, a dry cough, wheezing and chest pain.

No one has come up with a satisfactory explanation of why this disease happens. Theories abound, but none has been proven.

Your six-month checkup was wonderful news. The process has not progressed. Often it does.

No single drug has found acceptance as the one best treatment. Supplemental oxygen controls symptoms when blood oxygen levels drop. The ultimate remedy for pulmonary fibrosis, if it has reached the point where sustaining blood oxygen levels are impossible, is lung transplant. You may never reach that stage. The course of this illness is quite unpredictable.

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Dr. Donohue

Last modified: June 10, 2012