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Peripheral arterial disease and isolated systolic hypertension: the ATTEST study
M E Safar1, P Priollet, F Luizy
1Faculté de Médecine, Hôtel-Dieu hospital, Université Paris Descartes, Paris, France.
Insights
Hypertension significantly impacts cardiovascular diseases. Isolated systolic hypertension is linked to peripheral artery disease, while systolic-diastolic hypertension is associated with coronary and cerebrovascular diseases.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- Hypertension is a major risk factor for cardiovascular diseases (CV), including coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease (CVD).
- Past research has insufficiently explored the links between specific hemodynamic features of hypertension and different localizations of CV disease.
Purpose of the Study:
- To investigate the relationships between blood pressure classifications and the prevalence of specific cardiovascular diseases (PAD, CAD, CVD) in a large primary care population.
- To identify distinct clinical profiles associated with different types of hypertension in patients with established CV disease.
Main Methods:
- The ATTEST study enrolled 8316 consecutive patients with CV diseases from 3020 general practitioners.
- Blood pressure was measured and classified (normotensive, controlled hypertension, isolated systolic hypertension, systolic-diastolic hypertension).
- Multiple regression analysis was used to correlate blood pressure types with CV disease manifestations and risk factors.
Main Results:
- 80% of the study population had hypertension, with isolated systolic hypertension being the most prevalent form (42%).
- Isolated systolic hypertension was associated with peripheral artery disease (PAD) and less commonly with coronary artery disease (CAD) or cerebrovascular disease (CVD).
- Systolic-diastolic hypertension was linked to CAD and/or CVD, but not PAD, and was influenced by age, dyslipidemia, and diabetes mellitus.
Conclusions:
- Hypertension is highly prevalent in patients with CV disease in primary care settings.
- Distinct hypertension profiles correlate with specific cardiovascular disease patterns.
- Treating isolated systolic hypertension is crucial for secondary prevention in patients with PAD.
Abstract:
Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association). Blood pressure, which was not an inclusion criterion, was then measured and related to the different forms of CV diseases. Blood pressure classification involved 20% normotensive subjects, 24% subjects with controlled hypertension, 42% subjects with isolated systolic hypertension and 14% subjects with systolic-diastolic hypertension, all hypertensives with or without antihypertensive therapy. From multiple regression analysis, it appeared that subjects with systolic hypertension were characterized by the presence of PAD, with little or no presence of CAD and/or CVD. Subjects with systolic-diastolic hypertension were characterized by the presence of CAD and/or CVD, but without PAD. Although the former was only influenced by age, dyslipidaemia and diabetes mellitus influenced the latter. This study confirms the high prevalence of hypertension (80%) in a large population of patients with CV diseases selected in primary care. Analysis of different features of hypertension revealed that isolated systolic hypertension was the most prevalent form of hypertension in this treated population. Finally, one of the predominant goals of secondary prevention in subjects with PAD should be the treatment of isolated systolic hypertension.
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