Marat Fudim1, Charles W Hopley2, Zhen Huang1, Sarah Kavanagh3, Frank W Rockhold1, Iris Baumgartner4, Jeffrey S Berger5, Juuso I Blomster6, F Gerry R Fowkes7, Brian G Katona8, Kenneth W Mahaffey9, Lars Norgren10, Cara Ostrom3, Manesh R Patel1, W Schuyler Jones1, William R Hiatt11. 1. Duke Clinical Research Institute, Department of Medicine, Duke University School of Medicine, Durham, NC (M.F., Z.H., F.W.R., M.R.P., W.S.J.). 2. Department of Medicine, Section of Nephrology and Hypertension, Geisel School of Medicine at Dartmouth College, Hanover, NH (C.W.H.). 3. CPC Clinical Research, Aurora, CO (S.K., C.O.). 4. Swiss Cardiovascular Center, University of Bern, Switzerland (I.B.). 5. Departments of Medicine and Surgery, New York University School of Medicine (J.S.B.). 6. University of Turku, Finland (J.I.B.). 7. University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, United Kingdom (F.G.R.F.). 8. AstraZeneca, Gaithersburg, MD (B.G.K.). 9. Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.). 10. Orebro University, Faculty of Medicine and Health, Sweden (L.N.). 11. Department of Medicine University of Colorado School of Medicine, Division of Cardiology, and CPC Clinical Research, Aurora (W.R.H.).
Abstract
BACKGROUND: Current guidelines recommend aggressive management of hypertension. Recent evidence suggested potential harm with low blood pressure targets in patients with peripheral artery disease. We investigated the association of a history of hypertension and office systolic blood pressure (SBP) with major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). METHODS AND RESULTS: The EUCLID trial (Examining the Use of Ticagrelor in Peripheral Artery Disease) included 13 885 participants with symptomatic peripheral artery disease; median follow-up was 30 months. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for any MACE, MALE, and MALE including lower extremity revascularization. A clinical history of arterial hypertension was present in 10 857 (78%) participants, and these participants were older and more likely to be female when compared with the 3026 (22%) patients without hypertension. In patients with a history of hypertension, the adjusted hazard ratio for MACE was 0.94, 95% CI, 0.82-1.08; P=0.39, and the adjusted hazard ratio for MALE was 1.08, 95% CI, 0.96-1.23; P=0.21. During follow-up, average SBP was 135 mm Hg (125-145). Every 10 mmHg increase in SBP>125 mmHg was associated with an increased risk of MACE (HR, 1.10 [95% CI, 1.06-1.14]; P<0.001), a marginally increased risk of MALE (HR, 1.07 [95% CI, 1.00-1.15]; P=0.062), and an increased risk of MALE/lower extremity revascularization (HR, 1.08 [95% CI, 1.04-1.11]; P<0.001). Every decrease in 10 mmHg SBP ≤125 mmHg was associated with an increased risk of MACE (HR, 1.19 [95% CI, 1.09-1.31]; P<0.001) but not MALE or MALE/lower extremity revascularization (HR, 1.02 [95% CI, 0.84-1.23], P=0.824; HR, 1.04 [95% CI, 0.95-1.13], P=0.392, respectively). CONCLUSIONS: History of hypertension was not associated with higher hazard for MACE or MALE in patients with peripheral artery disease. In contrast, there was a higher hazard of MACE in patients with out-of-target low and high SBP. High but not low SBP was associated with an increased risk of ischemic limb events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01732822.
BACKGROUND: Current guidelines recommend aggressive management of hypertension. Recent evidence suggested potential harm with low blood pressure targets in patients with peripheral artery disease. We investigated the association of a history of hypertension and office systolic blood pressure (SBP) with major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). METHODS AND RESULTS: The EUCLID trial (Examining the Use of Ticagrelor in Peripheral Artery Disease) included 13 885 participants with symptomatic peripheral artery disease; median follow-up was 30 months. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for any MACE, MALE, and MALE including lower extremity revascularization. A clinical history of arterial hypertension was present in 10 857 (78%) participants, and these participants were older and more likely to be female when compared with the 3026 (22%) patients without hypertension. In patients with a history of hypertension, the adjusted hazard ratio for MACE was 0.94, 95% CI, 0.82-1.08; P=0.39, and the adjusted hazard ratio for MALE was 1.08, 95% CI, 0.96-1.23; P=0.21. During follow-up, average SBP was 135 mm Hg (125-145). Every 10 mmHg increase in SBP>125 mmHg was associated with an increased risk of MACE (HR, 1.10 [95% CI, 1.06-1.14]; P<0.001), a marginally increased risk of MALE (HR, 1.07 [95% CI, 1.00-1.15]; P=0.062), and an increased risk of MALE/lower extremity revascularization (HR, 1.08 [95% CI, 1.04-1.11]; P<0.001). Every decrease in 10 mmHg SBP ≤125 mmHg was associated with an increased risk of MACE (HR, 1.19 [95% CI, 1.09-1.31]; P<0.001) but not MALE or MALE/lower extremity revascularization (HR, 1.02 [95% CI, 0.84-1.23], P=0.824; HR, 1.04 [95% CI, 0.95-1.13], P=0.392, respectively). CONCLUSIONS: History of hypertension was not associated with higher hazard for MACE or MALE in patients with peripheral artery disease. In contrast, there was a higher hazard of MACE in patients with out-of-target low and high SBP. High but not low SBP was associated with an increased risk of ischemic limb events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01732822.
Authors: William E Hughes; David P Treichler; Kenichi Ueda; Joshua M Bock; Darren P Casey Journal: Nutr Metab Cardiovasc Dis Date: 2021-12-08 Impact factor: 4.222
Authors: Lars Norgren; Rebecca North; Iris Baumgartner; Jeffrey S Berger; Juuso I Blomster; William R Hiatt; W Schuyler Jones; Brian G Katona; Kenneth W Mahaffey; Hillary Mulder; Manesh R Patel; Frank W Rockhold; F Gerry R Fowkes Journal: Vasc Med Date: 2021-09-13 Impact factor: 3.239