Download Poor blood pressure control in peripheral arterial

Proceedings of the British Pharmacological Society at http://www.pA2online.org/abstracts/Vol11Issue3abst086P.pdf
Poor blood pressure control in peripheral arterial disease associated with
increased risk of critical limb ischaemia: a multicentre prospective audit
Mahmud Saedon1, Athanasios Saratzis3, Magdalena Dinkel1, Ling Kho1, Asif
Mahmood2, Christopher Imray2, Donald Singer1,2. 1University Of Warwick, Coventry,
UK, 2University Hospitals Coventry and Warwickshire, Coventry, UK, 3Heart of
England NHS Foundation Trust, Birmingham, UK
Background: Hypertension increases the incidence and severity of peripheral arterial
disease (PAD). We assessed the prevalence of undertreated hypertension in patients
with PAD.
Methods: We used NICE Clinical Guideline CG127 as audit standard for blood
pressure (BP) control [<140mmHg systolic and <90mmHg diastolic] to assess
prospectively the adequacy of BP-control in 176 patients [age 70±10 years, 32 (18%)
females] who had been referred by their GPs to Vascular Surgery Clinics in two
separate regions of the West Midlands. Blood-Pressure was measured according to
British Hypertension Society (BHS) guidelines using a validated device. Overall, 66
(38%) patients had critical lower limb ischaemia at baseline. Fifty-five (31%) were
diabetic; 132 (75%) were receiving anti-platelet agents and 138 (78%) a statin.
Results: Mean BP was 143/80±19/17mmHg and 140 patients (80%) were already on
drug treatment for hypertension when referred; 90 (51%) had a systolic
BP>140mmHg, 42 (24%) a diastolic BP>90mmHg, and 32 (18%) had both. Blood
pressure treatment was not guideline-compliant in 101 (57%) patients. Mean BP was
148/82±21/21mmHg for those with critical-ischaemia at baseline versus
141/79±17/15mmHg for those without (p=0.02). Non-compliance with guidelines was
associated with presence of critical-ischaemia (71% versus 29%, p=0.01). Use of
statins [78% versus 79% (critical-ischaemia), p=0.96] and use of antiplatelets (76%
versus 74%, p=0.86) was not associated with critical-ischaemia at baseline.
Conclusion: Hypertension is undertreated in peripheral arterial disease despite wellestablished National Guidelines. Patients with undertreated hypertension were more
likely to present with critical ischaemia in this cohort. Our results support urgent
review of blood pressure assessment and treatment in peripheral arterial disease, both
in the community and in hospital-based services.