Introduction: Patients with peripheral artery disease (PAD) are known to have the highest cardiovascular risk across the spectrum of patients with atherothrombotic disease. Hypertension (HTN) management is currently not a key performance measure for PAD despite being a common risk factor in patients with PAD. As there is lack of data on the management of blood pressure (BP) in PAD, we prospectively studied BP management among patients with new or worsening symptomatic PAD.
Methods: In PORTRAIT, patients were evaluated for new or worsening PAD symptoms in 16 PAD clinics across the US, Netherlands and Australia. BP was measured in clinic and at time of enrollment. HTN was defined as prior history of HTN, use of antihypertensives or [SBP ≥140 or DBP ≥90 mmHg per old guidelines; or SBP≥130 or DBP≥80 per new ACC/AHA guidelines]. Untreated HTN was defined as patients with HTN who were not on antihypertensive therapy. HTN with BP <140/90 (old) or <130/80 (new guidelines) was defined as controlled HTN. We estimated country differences in BP and untreated HTN rates. Median odds ratio (MOR) and 95% confidence intervals was derived from hierarchical logistic regression modelling to estimate variability in achieving controlled HTN.
Results: Among 1006 participants with documented BP, the prevalence of HTN increased from 96% to 98% based on old and new definitions respectively. BP control decreased from 51% (old) to 31% (new definition). Beta blockers (66.1%) were the most commonly used antihypertensive drug class (Table 1). Overall, 6.5% and 8.3% of HTN patients were untreated based on the old and new definitions respectively. Mean BP was lowest in the US compared to Netherlands and Australia (135/73 ± 21/11 mmHg, 146/76 ± 22/12, 151/80 ± 19/10, p <0.001) respectively. The MOR across sites was 1.7 (1.3 -2.5) for BP <140/90 (p <0.001), and 1.4 (1.0 -2.1) for BP<130/80 (p = 0.045) after adjusting for country.
Conclusion: The prevalence of HTN among PAD patients with new or worsening symptoms was high independent of BP cut off. Based on new HTN definition, only 1 in 3 HTN patients in this cohort have controlled BP. There was significant heterogeneity in BP control and rates of untreated hypertension differed by country independent of HTN definition. This suggests an opportunity to improve BP control in PAD patients.