EFFECTIVENESS OF CONSERVATIVE TREATMENTS ON CHRONIC VENOUS DISEASE SYMPTOMS AND QUALITY OF LIFE IN HYPERTENSIVE PATIENTS: A SUBGROUP ANALYSIS FROM THE VEINSTEP OBSERVATIONAL STUDY

Abstract

Objective: Chronic venous disease (CVeD) and arterial hypertension (HTA) are common circulatory system disorders associated with significant patient and healthcare burdens. Despite their high prevalence, patients presenting with both conditions are poorly studied resulting in a lack of evidence regarding optimal CVeD management in this specific group. This VeinStep sub-analysis evaluates the effectiveness of conservative treatments on CVeD symptoms and QoL in hypertensive patients. Design and method: VeinStep was an international, observational, prospective study, involving outpatients with symptomatic CVeD. Patients underwent a clinical examination to identify CVeD signs using CEAP classification. Main outcomes after 4 weeks were intensity of symptoms (VAS) and QoL using CIVIQ14. Changes over time were analyzed using a Wilcoxon test. Between-group comparisons for most prescribed venoactive drugs (VADs) used ranked ANCOVA with baseline value as covariate, adjusted on main baseline characteristics. Results: Among the 6084 patients analyzed in VeinStep, 1230 had HTA. They were more frequently men (28.9% vs 20.3%), older (Mean age±SD: 61.5±11.5 vs 47.9±13.0 yrs), obese (BMI>30 kg/m2: 43.9% vs 27.0%) and had more severe CEAP class (>=C4:26.6% vs 9.5%) than non-HTA patients. Most prescribed treatments involved VADs (97.2% of patients) mainly combined with compression and/or topicals: Micronized Purified Flavonoid Fraction (MPFF):77.5%, diosmin:17.7%, compression:59.1%, topicals:43.7%. VADs treatment resulted in significant decreases vs baseline in global symptoms intensity:- 2.39±1.78 (p<0.001) and in each symptom intensity (p<0.001) along with significant improvement in QoL: CIVIQ-14 score decreased by -10.49±8.21 (p<0.001). For MPFF- or diosmin-based therapy, global symptoms intensity decreased by -2.50±1.73 and -1.87±1.85, respectively (p<0.001 in favor of MPFF). MPFF-based therapy showed a higher beneficial effect on pain:-2.42±1.83 vs -1.77±1.69 (P=0.002); heaviness:-2.53±1.86 vs -1.79±1.75 (P<0.001); swelling:-2.46±1.92 vs - 1.76±2.03 (P<0.001); cramps:-2.15±1.96 vs -1.53±1.76 (P=0.002) and QoL:-10.94±8.02 vs - 9.07±8.87 (P=0.012) compared with diosmin-based therapy. Conclusions: This VeinStep sub-analysis offers valuable insights into the patient characteristics with both CVeD and HTA in real-life settings, guiding clinicians in selecting optimal treatments for improved outcomes. The findings suggest that VADs, particularly MPPF, significantly reduce CVeD symptoms and improve QoL in this population.