Title:Hypertension Management in Peripheral Artery Disease: A Mini Review
Volume: 20
Issue: 1
Author(s): A. Kharawala, S. Nagraj, S. Pargaonkar, J. Seo, D.G. Kokkinidis*S.E. Altin
Affiliation:
- Section of Cardiovascular
Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
Keywords:
Hypertension, peripheral artery disease, systolic blood pressure, diastolic blood pressure, guideline-based management, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker.
Abstract: Lower extremity peripheral artery disease (PAD) affects over 230 million adults globally,
with hypertension being one of the major risk factors for the development of PAD. Despite
the high prevalence, patients with hypertension who have concomitant PAD are less likely to receive
adequate therapy. Through this review, we present the current evidence underlying hypertension
management in PAD, guideline-directed therapies, and areas pending further investigation.
Multiple studies have shown that both high and relatively lower blood pressure levels are
associated with worse health outcomes, including increased morbidity and mortality. Hence,
guideline-directed recommendation involves cautious management of hypertensive patients with
PAD while ensuring hypotension does not occur. Although any antihypertensive medication can
be used to treat these patients, the 2017 American Heart Association/American College of Cardiology
(AHA/ACC), 2017 European Society of Cardiology (ESC), and 2022 Canadian guidelines
favor the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor
blockers (ARB) as the initial choice. Importantly, data on blood pressure targets and treatment of
hypertension in PAD are limited and largely stem from sub-group studies and post-hoc analysis.
Large randomized trials in patients with PAD are required in the future to delineate hypertension
management in this complex patient population.
