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Blood Pressure and Risk of Clinical Events in Peripheral Artery Disease
Saket Girotra1, Mary Vaughan-Sarrazin2, James A de Lemos3
1University of Texas Southwestern Medical Center, North Texas Veterans Affairs Medical Center, Dallas, TX.
Medrxiv : the Preprint Server for Health Sciences
|November 19, 2025
Summary
Current blood pressure guidelines for peripheral artery disease (PAD) may increase limb event risk. Lowering blood pressure (BP) too much can harm limb perfusion, suggesting a need for revised PAD BP goals.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Hypertension Research
Background:
- Current guidelines suggest a blood pressure (BP) goal of ≤130/80 mm Hg for peripheral artery disease (PAD) patients.
- Few PAD patients were included in landmark BP-lowering trials, and limb events were not assessed.
- Intensive BP control may negatively impact limb perfusion in PAD patients.
Purpose of the Study:
- To evaluate the association between longitudinal BP values and the risk of cardiovascular and limb events in US Veterans with PAD.
- To determine if current BP guidelines are optimal for PAD patients, considering both cardiovascular and limb outcomes.
Main Methods:
- Utilized data from a longitudinal registry of 91,296 US Veterans diagnosed with PAD between 2015-2020.
- Employed multivariable Cox regression models with time-varying BP as exposure.
- Assessed risks for cardiovascular events (myocardial infarction, stroke) and limb events (chronic limb-threatening ischemia, major amputation).
Main Results:
- Higher systolic BP (≥140 mm Hg) was linked to increased cardiovascular event risk.
- The association between systolic BP and limb events was U-shaped, with elevated risk at both low (<110 mm Hg) and high (≥160 mm Hg) levels.
- This discordance was more pronounced in patients with diabetes and severe PAD.
Conclusions:
- Current BP recommendations for PAD optimize cardiovascular risk but may increase limb event risk.
- There is a critical need to redefine BP goals for PAD patients, particularly those susceptible to limb events.
- Individualized BP management strategies may be necessary for PAD patients to balance cardiovascular and limb perfusion risks.
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