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

Abstract

Peripheral artery disease (PAD), a condition where there is reduced blood flow due to narrowing or blockage of the arteries of the peripheral vasculature, is an epidemic that currently affects eight million people in the United States alone and is a major risk equivalent to having active coronary artery disease (CAD). However, it is commonly underdiagnosed in the general population. Hypertension is a common cardiovascular condition characterized by elevated blood pressure levels. There are several mitigating risk factors that can reduce the risk of complications of PAD, with hypertension playing a major role. This literature review aims to explore the relationship between hypertension and PAD, including their shared risk factors, pathophysiological mechanisms, and management strategies. In addition, we will analyze how this impacts major cardiovascular outcomes, such as critical limb ischemia, vascular amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular-related death by examining relevant studies, current guidelines, and evidence. This literature review is intended to guide practitioners on ideal blood pressure parameters and evidence-based anti-hypertensives that provide overall cardiovascular benefit in both the primary care and hospital-based setting. By understanding the association between hypertension and PAD and the underlying pathophysiological mechanisms, healthcare professionals can improve diagnosis, treatment, and management strategies for affected individuals.

Keywords: ankle-brachial index; claudication time; hypertension; maximal walking distance; peripheral artery disease.

Figure 1. Image demonstrating 2D views of a normal blood vessel (left) and blood vessel with unruptured atheroma (right)

Figure 2. Graphic illustration of the pathophysiology of peripheral artery disease

PAD, peripheral arterial disease; RAAS, renin-angiotensin-aldosterone system Citation: [1-3,5]