Poredoš Pavel, Mikhailidis Dimitri P, Paraskevas Kosmas I, Blinc Aleš, Antignani Pier L, Stanek Agata, Mansilha Armando, Cevc Matija
Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL), London, UK.
Int Angiol. 2024 Oct;43(5):541-547. doi: 10.23736/S0392-9590.24.05242-8. Epub 2024 Nov 19.
Hypertension is a major risk factor for peripheral arterial atherosclerotic disease (PAD). Hypertension deteriorates arterial wall function and the morphology of all layers of arteries. Endothelial cell injury enhances permeability and promotes migration of cholesterol and monocytes into the vessel wall. Increased blood pressure (BP) through hyperplasia of smooth muscle cells initiates remodeling of the arterial wall that increases peripheral resistance. Further, hypertension, particularly in patients with dyslipidemia, provokes atherosclerosis in different vascular territories, including the lower legs. Guidelines recommend treatment of hypertension in patients with PAD to reach the target BP of <130/80 mmHg. However, systolic BP (SBP) <120 mmHg may worsen oxygen delivery to the diseased leg and is related to a higher rate of cardiovascular (CV) events. Therefore, there is a J-shape relationship between SBP and the rate of primary outcomes. Any class of antihypertensive drugs, including beta-blockers, can be used for the treatment of hypertension in patients with PAD. Angiotensin converting enzyme (ACE) inhibitors may have some additional benefit over other antihypertensive drugs including improvement of perfusion of the diseased leg and are recommended even in patients with critical limb ischemia. In conclusion: hypertensive patients with PAD are at increased risk for CV events and treatment of raised BP is indicated, but SBP <120 mmHg and DBP <70 mmHg may contribute to adverse limb outcomes and other CV events. Consequently, PAD patients may require a different BP target than those without PAD.
高血压是外周动脉粥样硬化疾病（PAD）的主要危险因素。高血压会损害动脉壁功能以及动脉各层的形态。内皮细胞损伤会增加通透性，并促进胆固醇和单核细胞迁移至血管壁。血压升高通过平滑肌细胞增生引发动脉壁重塑，进而增加外周阻力。此外，高血压，尤其是在血脂异常患者中，会在包括小腿在内的不同血管区域引发动脉粥样硬化。指南建议对PAD患者进行高血压治疗，使血压目标值达到<130/80 mmHg。然而，收缩压（SBP）<120 mmHg可能会使患病下肢的氧输送恶化，并与更高的心血管（CV）事件发生率相关。因此，SBP与主要结局发生率之间存在J形关系。任何一类抗高血压药物，包括β受体阻滞剂，均可用于治疗PAD患者的高血压。与其他抗高血压药物相比，血管紧张素转换酶（ACE）抑制剂可能具有一些额外益处，包括改善患病下肢的灌注，即使在严重肢体缺血患者中也推荐使用。总之：患有PAD的高血压患者发生CV事件的风险增加，需要对血压升高进行治疗，但SBP<120 mmHg和舒张压（DBP）<70 mmHg可能会导致不良肢体结局和其他CV事件。因此，PAD患者可能需要与无PAD患者不同的血压目标值。
