Screening for abdominal aortic aneurysms in a hypertensive patient population

Background: Abdominal aortic aneurysm (AAA) is an important cause of preventable death in the elderly. Objective: To search for an effective screening pro gram for the detection of AAA. Methods: We consecutively and prospectively screened 240 male, predominantly white, patients, aged 60 to 75 years, by ultrasound for the presence of AAA in 2 phases: in screen 1, hypertension (diastolic blood pressure reading >95 mm Hg) was the only selection criterion; in screen 2, we included hypertensive patients with a systolic blood pressure level higher than 175 mm Hg with or without antihypertensive therapy, transient ischemic attacks and/or stroke, and claudication. Results: The yield of AAAs in screens 1 and 2 was 3% and 11%, respectively (P<.02, X² analysis). No AAAs were found in patients with uncomplicated hypertension. Of the cardiovascular complications, only claudication was independently associated with the presence of AAA (relative risk, 5.8; confidence interval, 1.818.6; P=.004). Conclusions: Screening for AAA is recommended for elderly white patients with claudication. Uncomplicated hypertension by itself is not an indication for screening.