SAVS - Chronic Hypertension Management Affects Revascularization Outcomes in Peripheral Arterial Disease

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Chronic Hypertension Management Affects Revascularization Outcomes in Peripheral Arterial Disease
Andrew Pan Huang, Luciano Delbono, Robert Beaulieu, Craig Brown, Nimesh Anantlal Patel, Peter Henke
University of Michigan, Ann Arbor, MI

INTRODUCTION: Chronic hypertension is a common and challenging disease process, often existing in the gray area of management between the vascular surgeon and the primary care provider. However, its role in affecting long term PAD outcomes has not been clearly described.
METHODS: All open and endovascular lower extremity revascularization cases from 6/1/2014 to 7/10/2025 were selected with medication data abstracted at the time of every Ankle Brachial Index (ABI) or Duplex exam. Up to 100 outpatient blood pressures were averaged for each patient. Patients were then classified into Normotensive (<130 mmHg), Stage I hypertension (130-140 mmHg), and Stage II hypertension (140+ mmHg). The chosen outcome was amputation free survival (AFS).
RESULTS: 1962 patients underwent lower extremity revascularization and are characterized in Table 1. At all timepoints, normotensive patients on 0-1 classes of antihypertensives have higher AFS than normotensive patients on 2+ classes (p<0.001) (Figure 1A). This phenomenon was similar in the Stage I hypertension patients (p<0.007) (Figure 1B). Interestingly, amongst the Stage II hypertension patients, there was no difference in AFS regardless of how many antihypertensives patients were on (Figure 1C). Normotensive patients on 2+ and Stage I or II patients with 3+ antihypertensive classes showed no difference in AFS (Figure 2). In the late setting (>1000 days), normotensive, Stage I, and Stage II hypertension are at increasingly higher risks of amputation or death (p<0.05). Selected cohort demographic details are shown in Table 1 for review.
CONCLUSIONS: Good hypertension control in patients having undergone revascularization for PAD directly impacts AFS. Despite prescription of agents, those with Stages I and II hypertension were at higher risk of amputation or death than those with good control. It is unclear whether these agents did not provide benefit or suggests patient non-compliance, which could not be evaluated in this study. This data suggests that vascular surgeons and primary care providers should coordinate blood pressure control in patients with PAD and concomitant hypertension as it directly affects postoperative outcomes.
Figure 1.

Figure 2.

Table 1.

Cohort Demographics
Variable	Normotensive (n = 891)	Stage 1 Hypertension (n = 483)	Stage 2 Hypertension (n = 588)	p-value
Proportion with PCP	0.910�0.286	0.941�0.236	0.934�0.248	0.073
Age at First Intervention	61.8�16.4	65.9�12.2	68.4�11.8	<0.001
Total OR Cases	2.4�2.1	2.5�1.9	2.5�1.9	0.941
Proportion on Dialysis	0.024�0.152	0.041�0.199	0.058�0.234	0.003
Average Creatinine	1.3�1.1	1.4�1.2	1.6�1.3	<0.001
Highest A1c	7.6�2.5	8.3�10.5	7.9�2.6	0.172
# Antihypertensive Classes	1.2�1.2	1.5�1.2	1.8�1.2	<0.001
Any Statin	516 (57.9%)	299 (61.9%)	357 (60.7%)	0.300
High Intensity Statin	260 (29.2%)	151 (31.3%)	177 (30.1%)	0.721

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