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BP levels predict lower-extremity PAD events
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Patients with higher and lower systolic BP and pulse pressure, as well as those with lower diastolic BP, had higher rates of lower-extremity peripheral artery disease events, according to an analysis published in Circulation.
Nathan K. Itoga, MD, vascular surgery resident at Stanford University, and colleagues analyzed data from 33,357 patients (mean age, 67 years; 53% men) from the ALLHAT trial aged at least 55 years with hypertension at baseline, which was defined as BP greater than 140/90 mm Hg. Patients also had one other CAD risk factor such as history of CABG or angioplasty, history of stroke or MI, low HDL, diabetes, current cigarette smoking or left ventricular hypertrophy.
Those with LV ejection fraction less than 35%, history of HF and/or serum creatinine less than 2 mg/dL were excluded. This analysis also excluded patients who were assigned doxazosin due to its early termination in the original trial.
BP was measured at baseline and periodically after randomization at study visits. The median BP at baseline was 146/84 mm Hg.
The primary outcome of interest for this analysis was a lower-extremity PAD event, which was defined as PAD-related procedures, PAD-related hospitalization, PAD-related death or outpatient PAD medical treatment. Patients were followed up for a median of 4.3 years.
During follow-up, 4.5% of patients had a lower-extremity PAD event and 12.4% of patients died due to causes unrelated to PAD.
Compared with patients with a systolic BP between 120 mm Hg and 129 mm Hg, patients with a systolic BP less than 120 mm Hg had a 26% increased risk for a PAD event (P = .015), and patients with a systolic BP greater than 160 mm Hg had a 21% increased risk for a PAD event (P = .05) after adjusting for demographic and clinical characteristics.
Patients with a diastolic BP less than 60 mm Hg had a 72% increased risk for a lower-extremity PAD event (P < .001). Higher diastolic BP was associated with lower hazards, although it was not always statistically significant.
Lower and higher pulse pressures were associated with higher HRs for lower-extremity PAD events.
“The 2017 ACC/AHA blood pressure guidelines advocate a target BP of < 130/80 mm Hg for nearly all patients with hypertension for overall cardiovascular risk reduction, and our results suggest that this BP target may not be optimal with regard to lower-extremity PAD events,” Itoga and colleagues wrote. “Future studies are needed to refine BP targets for prevention of lower-extremity PAD events.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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