Lower-extremity arterial disease (LEAD) is common in older adults, particularly those with systolic hypertension. In a subgroup of 1,775 participants of the Systolic Hypertension in the Elderly Program, LEAD was assessed noninvasively by the ratio of the ankle to arm blood pressure, the ankle-arm index (AAI). LEAD was defined as an AAI of <0.9 in either leg. The prevalence of was 25% in white men, 38% in black men, 23% white women, and 41% women. About half of those with LEAD had mild disease (AAI, 0.8-0.9), and only 1-3% had a positive Rose questionnaire for intermittent claudication. The prevalence increased with age (p<0.01) and was consistently higher in blacks than whitesp><0.01), although there were no significant differences between men and women. Even in the absence of risk factors such as smoking and diabetes, blacks had a higher prevalence of LEAD than whites. Associations of LEAD with cardiovascular risk factors (high density lipoprotein cholesterol, systolic blood pressure, and smoking) appeared to be similar in blacks and whites, although relations were not always statistically significant in subgroups stratified by race and sex. Independent factors associated with the presence of LEAD included age, black race, smoking, diabetes mellitus, history of myocardial infarction or angina, systolic blood pressure, lower high density lipoprotein cholesterol, and body mass index. LEAD is common in older men and women with systolic hypertension, particularly blacks. However, very few have symptoms of claudication. Black participants with systolic hypertension, even those who are nondiabetic and those who have never smoked, appear to be at increased risk for LEAD.