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Blood pressure parameters and the risk of chronic limb-threatening ischemia: The Singapore Chinese Health Study
Ariel Fangting Ying1, Mohammad Talaei2, Shan Zhang3
1Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
Insights
Pulse pressure (PP) is the key blood pressure parameter linked to chronic limb-threatening ischemia (CLTI) risk. Reducing arterial stiffness may help prevent CLTI.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Epidemiology
Background:
- Hypertension is a known risk factor for chronic limb-threatening ischemia (CLTI).
- The specific influence of individual blood pressure parameters on CLTI risk remains unclear.
Purpose of the Study:
- To investigate the associations of systolic blood pressure (BP), diastolic BP, and pulse pressure (PP) with CLTI risk.
- To identify which BP parameters are independently associated with CLTI.
Main Methods:
- Prospective population-based cohort study using data from the Singapore Chinese Health Study (30,636 participants).
- Blood pressure was measured during 1999-2004; CLTI cases identified via hospital record linkage.
- Multivariable Cox models were used to examine associations between BP parameters and CLTI risk.
Main Results:
- After a mean follow-up of 13.6 years, 407 CLTI cases were identified.
- Individually, systolic BP, diastolic BP, and PP were positively associated with CLTI risk.
- Only pulse pressure remained independently associated with CLTI risk after adjusting for other BP parameters and risk factors (HR for highest vs. lowest PP category: 5.24).
Conclusions:
- Pulse pressure is the primary blood pressure parameter independently associated with CLTI risk.
- Findings suggest that targeting the reduction of arterial stiffness may be a strategy to decrease CLTI risk.
Background:
Although hypertension is an established risk factor for chronic limb-threatening ischemia (CLTI), little is known about how the individual blood pressure (BP) parameters could influence CLTI risk. We investigated associations of systolic BP, diastolic BP, and pulse pressure (PP) with CLTI risk in a prospective population-based cohort.
Methods:
We used data from the Singapore Chinese Health Study, involving 30,636 participants aged 46-85 years, with BP measured by trained interviewers during follow-up I interviews from 1999 to 2004. CLTI cases were identified via linkage to hospital records. Associations between various BP parameters and CLTI risk were examined via multivariable Cox models.
Results:
After a mean follow-up of 13.6 years, there were 407 incident CLTI cases. In individual models, all BP parameters were positively associated with CLTI risk in a stepwise manner. However, after pairwise adjustment for PP, systolic and diastolic BP were no longer associated with CLTI risk. Positive associations between different grades of hypertension and CLTI risk were also attenuated after adjusting for PP. Conversely, after adjustment for other BP parameters and vascular risk factors, PP remained independently associated with CLTI risk in a stepwise manner (P for trend ≤ .002). Compared with the lowest PP category (<40 mm Hg), the hazard ratio (95% confidence interval) was 5.24 (3.04-9.03) for the highest category (≥80 mm Hg).
Conclusions:
Our study found that only PP remained independently associated with CLTI risk after adjusting for other BP parameters and provided a basis for targeting reduction of arterial stiffness to decrease CLTI risk.
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:11Assessing Blood pressure in the Leg
Preparation:
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement