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Tiffany M. Powell, Robert J. Glynn, Mark A. Creager , Paul M. Ridker , Aruna D. Pradhan

Uncontrolled Hypertension, Systolic and Diastolic Blood Pressure and Development of Symptomatic Peripheral Arterial Disease in the Women’s Health Study (WHS). Tiffany M. Powell, Robert J. Glynn, Mark A. Creager , Paul M. Ridker , Aruna D. Pradhan Harvard Medical School

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Tiffany M. Powell, Robert J. Glynn, Mark A. Creager , Paul M. Ridker , Aruna D. Pradhan

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  1. Uncontrolled Hypertension, Systolic and Diastolic Blood Pressure and Development of Symptomatic Peripheral Arterial Disease in the Women’s Health Study (WHS) Tiffany M. Powell, Robert J. Glynn, Mark A. Creager, Paul M. Ridker, Aruna D. Pradhan Harvard Medical School Brigham and Women’s Hospital The authors have no conflicts of interest related to this research.

  2. Peripheral Arterial Disease • Increasing but under-diagnosed cardiovascular health issue • Affects up to 29% of Americans • Hypertension linked to PAD development • Lacking data on PAD risk prediction related to: • Systolic blood pressure (SBP) • Diastolic blood pressure (DBP) Criqui,M.H. et al. Vasc Med 2001, Murabito,J.M. et al. Am Heart J 2002

  3. Uncontrolled Hypertension • Up to two-thirds of Americans with hypertension are: • Untreated • Undertreated • Control of hypertension to current guidelines reduces coronary artery disease by 57% • How does blood pressure and control status relate to PAD risk? Wang,T.J. et al., Circulation 2005

  4. Systolic Blood Pressure and Diastolic Blood Pressure Coronary Artery Disease Cerebrovascular Disease ? ? Control Status Peripheral Arterial Disease

  5. Randomized, double-blind, placebo controlled trial of low-dose aspirin and Vitamin E for the primary 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 Women’s Health Study (WHS)

  6. Study Population 39,876 Women 534 Women Missing Baseline DBP 515 Women Missing Baseline SBP 51 Women Missing History and Treatment of HTN 39,261 Women with Complete exposure Data

  7. 39,261 Women Free of Symptomatic PAD with Complete Data on Blood Pressure Women with HTN Uncontrolled Treated and Controlled N = 2679 Untreated and Uncontrolled N = 3494 Without HTN N = 30300 Undertreated and Uncontrolled N = 2788 HTN defined as reported SBP > 140 mmHg and/or DBP > 90 mmHg, or on anti-hypertensive therapy

  8. Sept 2005 – 482 self-reported cases of symptomatic PAD Symptomatic PAD defined as: Intermittent claudication based on Edinburgh Claudication Questionnaire Documented peripheral arterial surgery inclusive of peripheral angioplasty or stenting 116 confirmed cases of PAD PAD Events in WHS

  9. Statistical Analysis • Continuous BP values assigned using mid-point of reported BP category. • Cox Proportional Hazards Regression • Hazard Ratios for incident PAD: • According to treatment and BP control status • SBP, DBP, Mean Arterial Pressure (MAP), Pulse Pressure (PP) per 10 mmHg and BP categories • Global model fit assessed by model log-likelihood statistics.

  10. Models of PAD Risk • Multivariate models adjusted for: • Age (logage) • Smoking (never/past/current) • Diabetes (no/yes) • BMI (continuous) • History of Elevated Cholesterol (no/yes cholesterol > 240 mg/dl) • Postmenopausal HT • Randomized treatment assignment with ASA/Vit E

  11. Baseline Characteristics

  12. Baseline Characteristics Values are mean  SD

  13. PAD Risk by Treatment and Control Status P for trend < 0.0001 Hazard Ratio

  14. 2.0 1.5 1.0 0.5 0 Multivariable HRs According to 10mmHg Increase in BP HR for PAD Per 10 mmHg increase in BP variable SBP DBP SBP and DBP MAP PP PP and MAP LRT: 169.61 178.21 184.23 177.50 184.31 184.31 df: 10 11 10 10 10 11

  15. Categories of Systolic Blood Pressure P for linear trend < 0.0001 Hazard Ratio

  16. Categories of Blood Pressure

  17. Limitations • Self-reported blood pressure subject to missclassification • Findings limited to symptomatic disease • Study population exclusively comprised of women

  18. 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.

  19. 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.

  20. Questions ?

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