Mahmud Saedon1, Mimi M Li2*, Athanasios Saratzis3 and Donald RJ Singer1,4
1Nottingham University Hospital NHS Trust, UK
2Department of Vascular Surgery, South Tees Hospitals NHS Foundation Trust, UK
3University of Warwick, UK
4Fellowship of Postgraduate Medicine, London, UK
Background: Hypertension is major risk-factor for Peripheral Arterial Disease (PAD). We prospectively assessed the prevalence of undertreated hypertension in patients presenting with PAD across a region in the UK and estimated its impact on presentation and outcome.
Methods: We prospectively assessed the adequacy of BP-control and hyperlipidaemia in 284 patients [age 71 ± 7 years (SD), 34 (12%) females] attending a PAD-clinic after being referred by their GP in two regional centers (West-Midlands, UK). NICE Guidance was used as standard to define hypertension [Blood Pressure (BP) >140 mmHg systolic and >90 mmHg diastolic]. BP was measured according to British Hypertension Society (BHS) guidelines. 105 (37%) patients had critical ischaemia at baseline and 94 (33%) were diabetic.
Results: Mean BP was 147/83 ± 21/18 mmHg, 131 patients (80%) were already on some treatment for hypertension when referred. 210 (74%) were receiving antiplatelet-agents and 204 (72%) a statin or other lipid-lowering medication; 202 (71%) were on “best medical therapy”. All individuals with critical limb ischaemia had a BP above the NICE standard. Blood-pressure treatment was not guideline-compliant in 55% of patients.
Conclusion: Hypertension is undertreated in PAD despite well-established guidelines. Undertreated patients were most likely to present with critical ischaemia and undergo amputation. Urgent review of hypertension treatment in PAD, both in the community and in hospital-based services, is necessary.
Saedon M, Li MM, Saratzis A, Singer DRJ. Inadequate Treatment of Hypertension in Peripheral Arterial Disease Affecting Patient Outcomes. World J Vasc Surg. 2019; 2(1): 1017.