Peripheral arterial disease and isolated systolic hypertension: The ATTEST Study

Abstract

Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association). Blood pressure, which was not an inclusion criterion, was then measured and related to the different forms of CV diseases. Blood pressure classification involved 20% normotensive subjects, 24% subjects with controlled hypertension, 42% subjects with isolated systolic hypertension and 14% subjects with systolic-diastolic hypertension, all hypertensives with or without antihypertensive therapy. From multiple regression analysis, it appeared that subjects with systolic hypertension were characterized by the presence of PAD, with little or no presence of CAD and/or CVD. Subjects with systolic-diastolic hypertension were characterized by the presence of CAD and/or CVD, but without PAD. Although the former was only influenced by age, dyslipidaemia and diabetes mellitus influenced the latter. This study confirms the high prevalence of hypertension (80%) in a large population of patients with CV diseases selected in primary care. Analysis of different features of hypertension revealed that isolated systolic hypertension was the most prevalent form of hypertension in this treated population. Finally, one of the predominant goals of secondary prevention in subjects with PAD should be the treatment of isolated systolic hypertension.

Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study

“…After deployment, a cyclic blood pressure of ±40 mmHg (i.e., pressure between 80 and 160 mmHg) was applied to the inner surface of the artery for a total of three cycles to simulate a case of isolated systolic hypertension, which has been reported to be the most frequent form of hypertension in patients suffering from PAD. 27 Blood flow computations investigated the effects of different oversizing ratios and the performances of both stents in a patient-specific artery. Following stent deployment, the deformed meshes of the artery and the stents were exported from Abaqus as open file formats (.obj) and converted to surface stl models using Solidworks 2013 (Dassault Systemes, Simulia Corp., RI, USA).…”

Hypertension and peripheral arterial disease

“…In the cohort of isolated PAD, ISH was more prevalent than systolic-diastolic hypertension, as opposed to the CAD/CVD cohort in whom the latter form was more prevalent. Safar et al 16 also report that all cardiovascular risk factors increase significantly across BP classification, from normotensive to controlled hypertension, ISH and systolic-diastolic hypertension. Whatever be the antihypertensive used, the proportion of treated patients using a particular agent was between 30 and 40%.…”

“…The antihypertensive of choice may also differ according to the dominant site of vascular disease as different drug classes are more efficient at preventing either cardiovascular or cerebrovascular complications. 15 In this issue of the Journal of Human Hypertension, Safar et al 16 report the associations between different forms of hypertension (isolated systolic hypertension (ISH), systolic-diastolic hypertension) with cardiovascular disease in different vascular territories as part of the ATTEST study. This relationship has been poorly evaluated in the past, and the ATTEST study 16 comprised 37.6% isolated PAD, 37.6% PAD with associated CAD and/or CVD and 24.8% CAD/CVD without PAD, reflecting the participant selection methods of the study (notably, two patients with PAD selected for every patient with CAD/CVD identified from general practice registers).…”

Can We Use β-Blocking Agents in Patients With Peripheral Artery Disease?

“…Hypertension often is associated with PAD 3 ; systolic hypertension is especially highly prevalent in PAD patients, most likely because of stiffening of the large arteries. 4 Thus, antihypertensive drugs will be necessary in many PAD patients.There is no convincing evidence of superiority of one antihypertensive drug over another with respect to controlling hypertension in PAD patients or affecting their claudication distance. 5 Slightly better results are obtained by ACE inhibitors, and in some studies an increase in muscle blood flow has been shown; this was accompanied by a limited increase in walking distance (for literature review, see Reference 5 ).…”

“…Hypertension often is associated with PAD 3 ; systolic hypertension is especially highly prevalent in PAD patients, most likely because of stiffening of the large arteries. 4 Thus, antihypertensive drugs will be necessary in many PAD patients.…”