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1、Uncontrolled Hypertension, Systolic and Diastolic Blood Pressure and Development of Symptomatic Peripheral Arterial Disease in the Womens Health Study (WHS),Tiffany M. Powell, Robert J. Glynn, Mark A. Creager, Paul M. Ridker, Aruna D. PradhanHarvard Medical School Brigham and Womens HospitalThe auth
2、ors have no conflicts of interest related to this research.,Peripheral Arterial Disease,Increasing but under-diagnosed cardiovascular health issueAffects up to 29% of AmericansHypertension linked to PAD developmentLacking data on PAD risk prediction related to: Systolic blood pressure (SBP) Diastoli
3、c blood pressure (DBP),Criqui,M.H. et al. Vasc Med 2001, Murabito,J.M. et al. Am Heart J 2002,Uncontrolled Hypertension,Up to two-thirds of Americans with hypertension are: Untreated UndertreatedControl of hypertension to current guidelines reduces coronary artery disease by 57%How does blood pressu
4、re and control status relate to PAD risk?,Wang,T.J. et al., Circulation 2005,Systolic Blood Pressure and Diastolic Blood Pressure,Peripheral Arterial Disease,Control Status,?,Womens Health Study (WHS),Randomized, double-blind, placebo controlled trial of low-dose aspirin and Vitamin E for the primar
5、y prevention of cardiovascular disease and cancer 39,876 U.S. female health professionals aged 45 years and older without prior history of CVD Self-reported systolic and diastolic blood pressure categories as well as treatment status obtained at baseline,Study Population,39,261 Women with Complete e
6、xposure Data,39,876 Women,515 Women Missing Baseline SBP,534 Women Missing Baseline DBP,51 Women Missing History and Treatment of HTN,39,261 Women Free of Symptomatic PAD with Complete Data on Blood Pressure,Without HTN N = 30300,Treated and Controlled N = 2679,Untreated and Uncontrolled N = 3494,Un
7、dertreated and Uncontrolled N = 2788,Women with HTN,Uncontrolled,HTN defined as reported SBP 140 mmHg and/or DBP 90 mmHg, or on anti-hypertensive therapy,PAD Events in WHS,Sept 2005 482 self-reported cases of symptomatic PADSymptomatic PAD defined as: Intermittent claudication based on Edinburgh Cla
8、udication Questionnaire Documented peripheral arterial surgery inclusive of peripheral angioplasty or stenting116 confirmed cases of PAD,Statistical Analysis,Continuous BP values assigned using mid-point of reported BP category.Cox Proportional Hazards RegressionHazard Ratios for incident PAD:Accord
9、ing to treatment and BP control status SBP, DBP, Mean Arterial Pressure (MAP), Pulse Pressure (PP) per 10 mmHg and BP categoriesGlobal model fit assessed by model log-likelihood statistics.,Models of PAD Risk,Multivariate models adjusted for: Age (logage) Smoking (never/past/current) Diabetes (no/ye
10、s) BMI (continuous) History of Elevated Cholesterol (no/yes cholesterol 240 mg/dl) Postmenopausal HT Randomized treatment assignment with ASA/Vit E,Baseline Characteristics,Baseline Characteristics,Values are mean SD,PAD Risk by Treatment and Control Status,Hazard Ratio,P for trend 0.0001,SBP,LRT:,1
11、84.23,df:,DBP,SBP and DBP,169.61,184.31,PP,177.50,MAP,178.21,PP and MAP,184.31,HR for PAD,Per 10 mmHg increase in BP variable,10,10,11,10,10,11,Multivariable HRs According to 10mmHg Increase in BP,Categories of Systolic Blood Pressure,P for linear trend 0.0001,Hazard Ratio,Categories of Blood Pressu
12、re,Limitations,Self-reported blood pressure subject to missclassificationFindings limited to symptomatic diseaseStudy population exclusively comprised of women,Conclusions,Uncontrolled hypertension is associated with incident symptomatic PAD in women. While all blood pressure variables assessed were associated with PAD incidence, SBP was the best single predictor in this analysis.,Implications,These data support a strong prognostic role for systolic blood pressure in the development of PAD in women.Identifies women with uncontrolled hypertension as a high-risk population.,Questions ?,
