Association of Blood Pressure Measurements With Peripheral Artery Disease Events

Itoga, Nathan K.; Tawfik, Daniel S.; Lee, Charles K.; Maruyama, Satoshi; Leeper, Nicholas J.; Chang, Tara I.

doi:10.1161/circulationaha.118.033348

Cited by 80 publications

(46 citation statements)

References 39 publications

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“…On-treatment observational studies have shown associations among lower DBP and higher rates of adverse cardiac ischemic events, particularly in populations with established coronary artery disease [1][2][3][4]12 . For example, a secondary observational reanalysis of 22,576 patients with hypertension and coronary artery disease enrolled in the International Verapamil-Trandolapril Study (INVEST) showed that patients with an achieved mean DBP of <60 mm Hg had a higher incidence of cardiovascular events and death compared with their counterparts who had a higher mean achieved DBP 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Coronary perfusion primarily occurs during diastole, and intensive systolic blood pressure (SBP) lowering often leads to diastolic blood pressure (DBP) lowering. In observational on-treatment analyses, lower DBP is associated with an increased risk of cardiovascular disease events and death in patients at higher risk for cardiovascular events [1][2][3][4] . Concern related to DBP lowering may be of particular relevance among patients with chronic kidney disease (CKD), given the higher prevalence of elevated SBP and lower DBP in that population, due in part to known associations of CKD with premature vascular aging and vascular stiffness 5,6 .…”

Section: Introductionmentioning

confidence: 99%

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Baseline Diastolic Blood Pressure and Cardiovascular Outcomes in SPRINT Participants with Chronic Kidney Disease

et al. 2020

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Background We sought to determine whether intensive systolic blood pressure (SBP) lowering was harmful in Systolic Blood Pressure Intervention Trial (SPRINT) participants with chronic kidney disease (CKD, estimated glomerular filtration rate < 60 ml/min/1.73 m 2) and lower baseline diastolic blood pressure (DBP). Methods We related baseline DBP with the SPRINT primary composite endpoint (myocardial infarction, acute coronary syndrome, stroke, acute decompensated heart failure, or cardiovascular death) and all-cause death. We examined the effect of intensive SBP lowering on these outcomes across the range of baseline DBP using Cox regression with treatment by baseline DBP interaction terms. Results Among 2646 SPRINT participants with CKD, lower baseline DBP was associated with a higher adjusted hazard of the primary composite endpoint and all-cause death. For example, baseline DBP 61 mm Hg (mean baseline DBP in the lowest tertile) experienced a 37% (95% CI 7% to 75%) higher hazard of the primary outcome relative to participants with baseline DBP of 75 mm Hg (mean baseline DBP for overall). The benefit of intensive SBP lowering was consistent across a range of baseline DBP on rates of the primary composite endpoint (linear interaction pvalue 0.56) and all-cause death (linear interaction p-values 0.20). Conclusions Among SPRINT participants with baseline CKD, lower DBP was associated with higher rates of the primary composite endpoint and all-cause death. However, DBP did not appear to modify the benefit of intensive SBP lowering on the primary composite endpoint or all-cause death. Our results suggest that lower DBP should not necessarily impede more intensive SBP lowering in patients with mild-to-moderate CKD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Baseline Diastolic Blood Pressure and Cardiovascular Outcomes in SPRINT Participants with Chronic Kidney Disease

et al. 2020

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“…In general, all patients with arterial hypertension benefit from a reduction in blood pressure [13], and patients with PAD ( = high-risk patients) in particular have an improved cardiovascular prognosis. In patients with PAD, RR < 120 mmHg and > 160 mmHg result in more leg events [14].…”

Section: Therapy Of Hypertension In Patients With Padmentioning

confidence: 99%

Position Paper on the Diagnosis and Treatment of Peripheral Arterial Disease (PAD) in People with Diabetes Mellitus

Balletshofer¹,

Ito

Lawall

et al. 2019

Exp Clin Endocrinol Diabetes

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“…Non-high-density lipoprotein cholesterol (non-HDL-c) includes both LDL-c and remnant cholesterol and has a stronger association with cardiovascular outcomes in comparison with LDL-c 9. Hypertension is associated with an increased risk of PAD and MALE in the general population 10 11. In patients with PAD, however, it has been suggested that lowering blood pressure below a critical level may worsen PAD symptoms and progression by decreasing peripheral perfusion 12.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk factors and the risk of major adverse limb events in patients with symptomatic cardiovascular disease

Hageman

Borst

Dorresteijn

et al. 2020

Heart

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AimTo determine the relationship between non-high-density lipoprotein cholesterol (non-HDL-c), systolic blood pressure (SBP) and smoking and the risk of major adverse limb events (MALE) and the combination with major adverse cardiovascular events (MALE/MACE) in patients with symptomatic vascular disease.MethodsPatients with symptomatic vascular disease from the Utrecht Cardiovascular Cohort - Secondary Manifestations of ARTerial disease (1996–2017) study were included. The effects of non-HDL-c, SBP and smoking on the risk of MALE were analysed with Cox proportional hazard models stratified for presence of peripheral artery disease (PAD). MALE was defined as major amputation, peripheral revascularisation or thrombolysis in the lower limb.ResultsIn 8139 patients (median follow-up 7.8 years, IQR 4.0–11.8), 577 MALE (8.7 per 1000 person-years) and 1933 MALE/MACE were observed (29.1 per 1000 person-years). In patients with PAD there was no relation between non-HDL-c and MALE, and in patients with coronary artery disease (CAD), cerebrovascular disease (CVD) or abdominal aortic aneurysm (AAA) the risk of MALE was higher per 1 mmol/L non-HDL-c (HR 1.14, 95% CI 1.01 to 1.29). Per 10 mm Hg SBP, the risk of MALE was higher in patients with PAD (HR 1.06, 95% CI 1.01 to 1.12) and in patients with CVD/CAD/AAA (HR 1.15, 95% CI 1.08 to 1.22). The risk of MALE was higher in smokers with PAD (HR 1.45, 95% CI 0.97 to 2.14) and CAD/CVD/AAA (HR 7.08, 95% CI 3.99 to 12.57).ConclusionsThe risk of MALE and MALE/MACE in patients with symptomatic vascular disease differs according to vascular disease location and is associated with non-HDL-c, SBP and smoking. These findings confirm the importance of MALE as an outcome and underline the importance of risk factor management in patients with vascular disease.

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Association of Blood Pressure Measurements With Peripheral Artery Disease Events

Abstract: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000542.

Cited by 80 publications

References 39 publications

Baseline Diastolic Blood Pressure and Cardiovascular Outcomes in SPRINT Participants with Chronic Kidney Disease

Baseline Diastolic Blood Pressure and Cardiovascular Outcomes in SPRINT Participants with Chronic Kidney Disease

Position Paper on the Diagnosis and Treatment of Peripheral Arterial Disease (PAD) in People with Diabetes Mellitus

Cardiovascular risk factors and the risk of major adverse limb events in patients with symptomatic cardiovascular disease

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