Impact of uncontrolled hypertension on 12-month clinical outcomes following below-the-knee arteries (BTK) interventions in patients with critical limb ischemia.

Sung Il Im,Byoung Geol Choi,Cheol Ung Choi,Seung-Woon Rha,Eung Ju Kim,Sun Ki Lee,Hong Seog Seo,Dong Joo Oh,Jin Oh Na,Ji Bak Kim,Hong Euy Lim,Jin Won Kim,Chang Gyu Park,Se Yeon Choi,Jae Joong Lee

doi:10.1186/s40885-016-0044-y

Abstract

BackgroundDespite intensive anti-hypertensive treatment, overall control rates of only 30 ~ 50 % have been reported in patients with hypertension (HTN). However, clinical significance and angiographic characteristics of patients with uncontrolled HTN following Below-the-knee arteries (BTK) interventions in patients with critical limb ischemia (CLI) are not clarified yet as compared to those with controlled HTN.MethodsA total 165 consecutive hypertensive patients with BTK lesions from August 2004 to November 2012 were enrolled for this study. Uncontrolled HTN was defined as a blood pressure of > 140 mmHg systolic and 90 mmHg diastolic under anti-hypertensive treatment. A total of 112 patients (67.8 %) had uncontrolled HTN. We compared the clinical and angiographic characteristics of patients with uncontrolled HTN following BTK interventions to those with controlled HTN at 12-month follow-up.ResultsThe baseline characteristics are well balanced between the two groups. At 12 months, there was no difference in the incidence of mortality, target lesion revascularization (TLR), target extremity revascularization (TER), and limb salvage rate in both groups. However, amputation rates were higher in patients with controlled HTN (33.9 vs. 19.6 %, P = 0.045).ConclusionRegardless of blood pressure control, HTN itself was an independent risk factor for BTK lesions, suggesting more intensive medical therapy with close clinical follow up will be required for all BTK patients with HTN.

Highlights

Despite intensive anti-hypertensive treatment, overall control rates of only 30 ~ 50 % have been reported in patients with hypertension (HTN)
critical limb ischemia (CLI) generally occurs in high risk patients with several risk factors including diabetes mellitus (DM), older age, HTN with extensive atherosclerotic disease of below-the-knee vessels
There was no difference in coronary angiographic characteristics between the two groups

Summary

Introduction

Despite intensive anti-hypertensive treatment, overall control rates of only 30 ~ 50 % have been reported in patients with hypertension (HTN). Clinical significance and angiographic characteristics of patients with uncontrolled HTN following Below-the-knee arteries (BTK) interventions in patients with critical limb ischemia (CLI) are not clarified yet as compared to those with controlled HTN. Hypertension (HTN) is probably the most common risk factor of atherosclerotic cardiovascular disease. It is well known that PAD is associated with increased risk of Critical limb ischemia (CLI), characterized by ischemic rest pain or tissue loss, represent the most advanced state of PAD, burdened by high morbidity and mortality. CLI generally occurs in high risk patients with several risk factors including DM, older age, HTN with extensive atherosclerotic disease of below-the-knee vessels.

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Results

Conclusion