ESH Excellence Center, Vascular Medicine Department.
Inserm UMR 1153-CRESS, Paris, France.
J Hypertens. 2021 Aug 1;39(8):1611-1620. doi: 10.1097/HJH.0000000000002821.
To contrast the association between blood pressure (BP) level and antihypertensive medications at hospital admission with 1-year mortality in patients undergoing revascularization for critical limb ischemia (CLI).
From November 2013 to May 2019, 315 consecutive patients were retrospectively included. A median of seven (IQR 3-13) separate readings were recorded for each patient before revascularization procedure and the average represented patient's mean BP. BP-lowering medications, clinical and biological parameters were recorded at baseline. The main outcome was total 1-year mortality.
The cohort included 172 men (55%) and 143 women (45%), with a mean age of 77.9 ± 11.9 years. Treated hypertension was present in 245 (78%) patients; 288 (91%) patients had BP-lowering drug prescriptions (2.1 ± 1.3 medications at baseline). Mean SBP, DBP, mean BP (MBP) and pulse pressure (PP) were 132 ± 18, 70 ± 8, 90 ± 10 and 62 ± 16mmHg. During 1-year follow-up, 80 (25.4%) patients died. In single-pressure multivariate analysis, SBP (hazard ratio 0.97; 95% CI 0.96-0.99; P = 0.005), MBP (hazard ratio 0.96; 95% CI 0.92-0.99; P = 0.01), PP (hazard ratio 0.97; 95% CI 0.95-0.99; P = 0.009), but not DBP, were inversely correlated with 1-year mortality, independently of age, coronary heart disease, left ventricular ejection fraction, brain natriuretic peptide, serum albumin, institutionalized status and antihypertensive drugs. Association between SBP, MBP and PP with 1-year mortality had a quite linear reverse pattern.
Among patients undergoing revascularization for CLI, there is an inverse correlation between admission SBP, MBP and PP with 1-year mortality. BP may represent a modifiable therapeutic target to prevent poor outcome in CLI patients.
对比入院时血压（BP）水平和降压药物与接受血运重建治疗的严重肢体缺血（CLI）患者 1 年死亡率的相关性。
2013 年 11 月至 2019 年 5 月，回顾性纳入 315 例连续患者。在血运重建术前，每位患者平均记录了 7（IQR 3-13）个单独的读数，平均值代表患者的平均 BP。在基线时记录了降压药物、临床和生物学参数。主要结局为总 1 年死亡率。
该队列包括 172 名男性（55%）和 143 名女性（45%），平均年龄为 77.9±11.9 岁。245 名（78%）患者存在治疗性高血压；288 名（91%）患者有降压药物处方（基线时 2.1±1.3 种药物）。平均 SBP、DBP、MBP 和脉压（PP）分别为 132±18、70±8、90±10 和 62±16mmHg。在 1 年随访期间，80 名（25.4%）患者死亡。在单压多变量分析中，SBP（风险比 0.97；95%CI 0.96-0.99；P=0.005）、MBP（风险比 0.96；95%CI 0.92-0.99；P=0.01）、PP（风险比 0.97；95%CI 0.95-0.99；P=0.009），但不是 DBP，与 1 年死亡率呈负相关，独立于年龄、冠心病、左心室射血分数、脑利钠肽、血清白蛋白、机构化状态和降压药物。SBP、MBP 和 PP 与 1 年死亡率之间的关联呈相当线性的反向模式。
在接受 CLI 血运重建的患者中，入院时 SBP、MBP 和 PP 与 1 年死亡率呈负相关。BP 可能是 CLI 患者预防不良结局的可改变治疗靶点。
