Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Mar 19;8(6):e010748.
doi: 10.1161/JAHA.118.010748.

Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients With Peripheral Artery Disease

Diana Thomas Manapurathe  1 , Joseph Vaughan Moxon  1   2 , Smriti Murali Krishna  1   2 , Sophie Rowbotham  1   3   4 , Frank Quigley  5 , Jason Jenkins  4 , Michael Bourke  1   6 , Bernard Bourke  6 , Rhondda E Jones  7 , Jonathan Golledge  1   2   8
Affiliations
Observational Study

Cohort Study Examining the Association Between Blood Pressure and Cardiovascular Events in Patients With Peripheral Artery Disease

Diana Thomas Manapurathe et al. J Am Heart Assoc. .

Abstract

Background Hypertension is an important risk factor for cardiovascular events in patients with peripheral artery disease; however, optimal blood pressure targets for these patients are poorly defined. This study investigated the association between systolic blood pressure ( SBP ) and cardiovascular events in a prospectively recruited patient cohort with peripheral artery disease. Methods and Results A total of 2773 patients were included and were grouped according to SBP at recruitment (≤120 mm Hg, n=604; 121-140 mm Hg, n=1065; and >140 mm Hg, n=1104). Adjusted Cox proportional hazards analyses suggested that patients with SBP ≤120 mm Hg were at greater risk of having a major cardiovascular event (myocardial infarction, stroke, or cardiovascular death) than patients with SBP of 121-140 mm Hg (adjusted hazard ratio, 1.36; 95% CI, 1.08-1.72; P=0.009). Patients with SBP >140 mm Hg had an adjusted hazard ratio of 1.23 (95% CI, 1.00-1.51; P=0.051) of major cardiovascular events compared with patients with SBP of 121-140 mm Hg. These findings were similar in sensitivity analyses only including patients receiving antihypertensive medications or focused on patients with a minimum of 3 months of follow-up. Conclusions This cohort study suggests that patients with peripheral artery disease and SBP ≤120 mm Hg are at increased risk of major cardiovascular events. The findings suggest caution in intensive SBP lowering in this patient group.

Keywords: blood pressure; major adverse cardiac event; myocardial infarction; peripheral artery disease; stroke.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan‐Meier survival curves illustrating freedom from major cardiovascular events (composite of myocardial infarction, stroke, or cardiovascular death), according to systolic blood pressure (SBP) in patients with peripheral artery disease. The red line represents patients with SBP between 121 and 140 mm Hg. The blue line represents patients with SBP >140 mm Hg, and the green line represents patients with SBP ≤120 mm Hg. Numbers below the table indicate the number of patients at risk at each time point. Differences were compared using the log‐rank test (P=0.029).
Figure 2
Figure 2
Kaplan‐Meier survival curves illustrating freedom from myocardial infarction (MI) according to systolic blood pressure (SBP) in patients with peripheral artery disease. The red line represents patients with SBP between 121 and 140 mm Hg. The blue line represents patients with SBP >140 mm Hg, and the green line represents patients with SBP ≤120 mm Hg. Numbers below the table indicate the number of patients at risk at each time point. Differences were compared using the log‐rank test (P=0.073).
See this image and copyright information in PMC

References

    1. Krishna SM, Moxon JV, Golledge J. A review of the pathophysiology and potential biomarkers for peripheral artery disease. Int J Mol Sci. 2015;16:11294–11322. - PMC - PubMed
    1. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UK, Williams LJ, Mensah GA, Criqui MH. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382:1329–1340. - PubMed
    1. Dormandy JA, Rutherford RB; TASC Working Group; Transatlantic Inter‐Society Consensus (TASC) . Management of peripheral arterial disease (PAD). J Vasc Surg. 2000;31:S1–S296. - PubMed
    1. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WRC, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). Circulation. 2006;113:e463–e654. - PubMed
    1. McDermott MM, Criqui MH, Greenland P, Guralnik JM, Liu K, Pearce WH, Taylor L, Chan C, Celic L, Woolley C, O'Brien MP, Schneider JR. Leg strength in peripheral arterial disease: associations with disease severity and lower‐extremity performance. J Vasc Surg. 2004;39:523–530. - PubMed

Publication types

MeSH terms