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 Carol, 
I can across an article that addressed the issue of decreasing ABI in
hypertensive patients. The  study demonstrated that ankle pressures were
similar to brachial pressures in normal patients as long as their brachial
systolic pressures were in a range between 100 mm Hg and 200 mm Hg. If BSP's
were less than 100 mmHg or greater than 200 mmHg, ankle pressures were 25 %
lower than BSP in these otherwise normal patients. Although your patient's
BSP did not exceed 200 mmHg, it's close. This could be an explanation. I'm
about 90% sure the article was in the book referenced below. Anybody got this
book?? Please check.

Belcaro e,t al, Noninvasive Diagnostic Techniques in Vascular Disease. E.
Bernstein , editor, third edition Page 507 Mosby, St. Louis

Rob Daigle