What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=243). Intervention: Cardiovascular risk factors (Chronic kidney disease). Primary outcome: Presence of ABI ≤ 0.9 (Peripheral arterial disease) (OR 6.7, 95% CI 2.04-21.8, p=0.002).

September 9, 2022Open Access

Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population

Key Result

In hypertensive patients, chronic kidney disease was independently associated with an increased risk of peripheral arterial disease (ABI ≤ 0.9) with an OR of 6.7.

Study Design

Type

Cohort (n=243)

Multicenter

Structured PICO

Population

243 consecutive adult Caucasian hypertensive patients from a primary care urban population in Spain. Mean age 68-76 across groups, 34-50% male. High prevalence of comorbidities including diabetes and CKD.

Outcome

Pre-existing or incident PAD (intermittent claudication, revascularization, amputation or ABI ≤ 0.9) as well as pre-existing or incident AS (ABI > 1.4), and composite endpoints of all-cause mortality or hospitalization; all-cause mortality, hospitalization and any CVD other than PAD; and any-cause mortality, hospitalization and global CVD.composite

In urban hypertensive patients, a low prevalence of ideal cardiovascular health was observed, and lower CVH scores along with abnormal ABI (≤0.9) were associated with worse clinical outcomes including mortality and hospitalizations.

Main Result

Effect estimate: OR 6.7 (95% CI 2.04-21.8)

p-value: p=0.002

Limitations

Relatively small sample size
Residual confounding cannot be excluded
Results may not be generalizable to other populations with a different context, age, race and lifestyle culture
Selection bias due to older, urban population with multiple comorbidities
Social desirability bias from self-reported data
Lack of data on adherence to anti-hypertensive drugs
Underestimation of hypertension-mediated organ damage prevalence due to lack of routine assessment
Unable to evaluate whether changes in cardiovascular health metrics reduce peripheral arterial disease risk

Abstract

BACKGROUND: Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes. METHODS: We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded. RESULTS: A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics. CONCLUSIONS: Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population.

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