Predictive value of admission blood pressure for 3-month mortality in patients undergoing revascularization for critical limb ischemia

Abstract

Objective: In patients with critical limb ischemia (CLI), blood pressure (BP) impact on mortality is unknown. We analyzed the predictive value of SBP, DBP and pulse pressure (PP) at hospital admission on 3-month mortality in patients with CLI undergoing revascularization procedure. Methods: From November 2013 to December 2018, 297 consecutive patients were retrospectively included. Admission BP was recorded using automated brachial sphygmomanometer, before revascularization procedure. A median of seven (IQR3–13) separate readings were recorded for each patient and the average represented patient's mean BP (mBP). Clinical and biological parameters were recorded at baseline. Results: The cohort included 163 men (55%) and 134 women (45%) with a mean age of 77.7 ± 11.9 years. Treated hypertension and diabetes were present in, respectively, 62 and 48% of patients. Mean SBP, DBP and PP were 132 ± 18, 70 ± 8 and 62 ± 16 mmHg. Thirty-four patients (11.4%) died during 3-month follow-up, mostly from cardiovascular causes. In univariate analysis, age, female sex, brain natriuretic peptide and C-reactive protein were positively correlated with mortality. BMI, mSBP, mDBP, mPP, hemoglobin, serum albumin and statin treatment were negatively correlated with mortality. In single-pressure multivariate analyses, mSBP (P = 0.024) and mPP (P = 0.030) were negatively correlated with mortality. Association between mSBP and mortality had an asymptotic curve pattern and SBP level 135 mmHg or less was significantly correlated with mortality. Conclusion: In patients undergoing revascularization for CLI, admission SBP is an independent predictor for short-term mortality with a negative relationship. SBP level 135 mmHg or less represents a warning sign to explore and correct associated comorbidities.

Low admission blood pressure as a marker of poor 1-year survival in patients with revascularized critical limb ischemia

“…The present results cannot prove a causal effect of low BP for mortality but suggest a possible prognostic marker. In this ongoing cohort study, the inverse correlation between SBP and short-term mortality recently highlighted following revascularization procedure for CLI [14], remains significant in the first year of follow-up. This pattern is different from that seen in patients with a milder PAD state, and approaches the SBP curve and related mortality in acute cardiovascular condition.…”

“…All patients presented with CLI, defined as documented atherosclerotic PAD in association with ischemic rest pain or tissue loss of the forefoot evolving for more than 2 weeks. Hemodynamic evaluation consisted of ankle-brachial pressure index (ABI) and great toe laser Doppler flowmetry (LDF) measurement, as previously described [8,14].…”

“…To date, no clinical trial focused on the issue of BP control for mortality in this patient population. We have recently described an inverse correlation between SBP level at hospital admission and 3-month mortality in CLI population undergoing endovascular revascularization [14]. Whether admission BP level retains its prognostic significance for morality in a longer term follow-up remains to be established in relation to antihypertensive treatment.…”

Hypertension in Patients With Peripheral Artery Disease: An Updated Literature Review

“…In particular, SBPs less than 135 were associated with increased mortality [17]. Another study looking at prognostic vitals found that resting heart rate correlated to mortality in PAD and heart rates >75 bpm increased the risk of all-cause mortality [18].…”