Key result
Peripheral arterial disease in hypertensive patients with coronary artery disease was associated with an increased risk of death, MI, or stroke (16.3% vs 9.2%; adjusted HR 1.26; 95% CI 1.13-1.40; P<0.0001).
Why the study?
Does attainment of guideline-directed target blood pressure improve outcomes in hypertensive patients with concomitant PAD and CAD?
Population
Hypertensive patients with concomitant peripheral arterial disease and coronary artery disease
Comparison
Attainment of target blood pressure vs Patients without PAD, and PAD patients achieving…
Design
Cohort
Follow-up
mean 2.7 years
Authors
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PAD signals higher CV risk in hypertensive CAD patients warranting vigilance; leaves open whether guideline BP targets improve outcomes or if higher SBP is preferable.
Cohort
Yes
Does attainment of guideline-directed target blood pressure improve outcomes in hypertensive patients with concomitant PAD and CAD?
Hazard Ratio: 1.26 (95% CI 1.13–1.4)
Absolute Event Rate: 16.3% vs 9.2%
p-value: p=<0.0001
In hypertensive patients with PAD and CAD, a J-shaped relationship exists between systolic blood pressure and adverse cardiovascular outcomes, suggesting optimal targets may be higher (135-145 mm Hg) than currently recommended.
Bavry et al. (2009) conducted a cohort in Hypertension with concomitant peripheral and coronary artery disease. Peripheral arterial disease (PAD) vs. Without PAD was evaluated on all-cause death, nonfatal myocardial infarction, or nonfatal stroke (adjusted HR 1.26, 95% CI 1.13 to 1.40, p=<0.0001). Peripheral arterial disease in hypertensive patients with coronary artery disease was associated with an increased risk of death, MI, or stroke (16.3% vs 9.2%; adjusted HR 1.26; 95% CI 1.13-1.40; P<0.0001).
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