Centre for Clinical Research, Uppsala University, Falun, Sweden.
Primary Health Care Center Britsarvet-Grycksbo, County of Dalarna, Falun, Sweden.
Ups J Med Sci. 2021 Apr 29;126. doi: 10.48101/ujms.v126.7609. eCollection 2021.
Patients with peripheral arterial disease (PAD) are generally less intensively managed than patients with coronary heart disease (CHD), despite that their risk of complications is believed to be equivalent. Identification of PAD patients at risk of poorly controlled blood pressure (BP) could lead to improved treatment, thus lowering the risk of cardiovascular (CV) complications. We aimed to describe the prevalence of poorly controlled cardiovascular (CV) risk factors, focusing on BP, in outpatients with PAD diagnosed in a vascular ultrasound laboratory.
Consecutive outpatients with carotid and/or lower extremity PAD were included ( 402) and examined with blood sampling, clinical BP, and 24-h ambulatory BP measurements. A poorly controlled clinical BP was defined as ≥140/90 mmHg, ambulatory BP ≥130/80 mmHg, low-density lipoprotein (LDL)-cholesterol level ≥2.5 mmol/L, and glycated hemoglobin (HbA1c) level >53 mmol/mol in those with diabetes.
Most of the patients had poorly controlled clinical (76.6%) and ambulatory BP (51.7%) profiles. Antihypertensive medications were prescribed in 84% of the patients. However, >40% of them used only 0-1 medication, and <25% of them used three or more agents. Clinical BP, a low number of medications, body mass index, and the presence of diabetes independently predicted a poorly controlled ambulatory BP. Nearly one-third of the patients were smokers, and most of the cohort had an LDL-cholesterol level of ≥2.5 mmol/L. An HbA1c level of >53 mmol/mol was present in 55% of diabetic patients.
Poorly controlled clinical and ambulatory systolic BP profiles were common. In addition, suboptimal control of other important CV risk factors was detected. The findings of this study highlight the need for better preventive efforts against CV risk factors in outpatients with PAD.
尽管外周动脉疾病（PAD）患者的并发症风险被认为与冠心病（CHD）患者相当，但他们的治疗管理通常不如 CHD 患者积极。识别有血压（BP）控制不良风险的 PAD 患者，可能会改善治疗，从而降低心血管（CV）并发症的风险。本研究旨在描述在血管超声实验室诊断为 PAD 的门诊患者中，心血管（CV）危险因素（重点是 BP）控制不良的流行情况。
连续纳入颈动脉和/或下肢 PAD 门诊患者（402 例），进行采血、临床 BP 和 24 小时动态 BP 测量。临床 BP 控制不良定义为≥140/90mmHg，动态 BP 控制不良定义为≥130/80mmHg，低密度脂蛋白（LDL）-胆固醇水平≥2.5mmol/L，糖尿病患者的糖化血红蛋白（HbA1c）水平>53mmol/mol。
大多数患者的临床和动态 BP 控制不良（分别为 76.6%和 51.7%）。84%的患者接受了降压药物治疗，但其中>40%的患者仅使用 0-1 种药物，<25%的患者使用 3 种或更多药物。临床 BP、药物种类少、体重指数和糖尿病的存在独立预测动态 BP 控制不良。近三分之一的患者为吸烟者，大多数患者的 LDL-胆固醇水平≥2.5mmol/L。55%的糖尿病患者的 HbA1c 水平>53mmol/mol。
临床和动态收缩压控制不良的情况较为常见。此外，还发现其他重要 CV 危险因素的控制也不理想。本研究结果强调了需要在外周动脉疾病门诊患者中加强 CV 危险因素的预防工作。
