gms | German Medical Science

29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Hochdruckliga e. V. DHL ® - Deutsche Hypertonie Gesellschaft Deutsches Kompetenzzentrum Bluthochdruck

23. bis 25.11.2005, Berlin

Combination of arterial hypertension and low ankle brachial index substantially increases total mortality risk in elderly patients

Substantiell erhöhte Mortalität älterer Patienten beim gleichzeitigem Vorliegen von arterieller Hypertonie und niedrigem Knöchel-Arm-Index

Meeting Abstract

  • C. Diehm - SRH Klinikum, Karsbad-Langensteinbach (Karlsbad, D)
  • H. Darius - Vinvates Klinikum Neukölln, Berlin (Berlin, D)
  • R. Haberl - Städtisches Krankenhaus Harlaching (München, D)
  • H.J. Trampisch - Städtisches Krankenhaus Harlaching (München, D)
  • B. Dasch - Ruhr Universität Bochum (Bochum, D)
  • J.R. Allenberg - Chirurgische Universitätsklinik, Heidelberg (Heidelberg, D)
  • B. von Stritzky - Sanofi-Aventis Berlin (Berlin, D)
  • M. Mahn - Sanofi-Aventis Berlin (Berlin, D)
  • D. Pittrow External link
  • G. Tepohl - Internist/Angiologe München (München, D)

Hypertonie 2005. 29. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Berlin, 23.-25.11.2005. Düsseldorf, Köln: German Medical Science; 2006. Doc05hochP110

The electronic version of this article is the complete one and can be found online at:

Published: August 8, 2006

© 2006 Diehm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Arterial hypertension (HYP) as well as peripheral arterial disease (PAD) are major risk factors for cardiovascular (CV) death and events. We aimed to investigate the risk of elderly patients with hypertension that have concomitant asymptomatic or symptomatic PAD.

344 representative primary care practices across Germany, trained and supervised by 34 specialists in vascular medicine, included a total of 6880 unselected patients aged >= 65 years (58% females, mean age 72.5 years, mean body mass index 27 kg/m2, 25% diabetics) in the longitudinal part of the observational German Trial on ankle brachial index (getABI). PAD was defined as ABI < 0.9 (Doppler sonography).

In the total cohort, the prevalence of (controlled or non-controlled) arterial hypertension according to physician diagnosis was 64.6%, of PAD 18.0%. The combined HYP + PAD prevalence was 14.1%.

(1) Patients with HYP + PAD had a substantially increased total/CV mortality risk at 3 years (11.1/5.0%) compared to patients without both diseases (4.6/0.9%); p<0.01 each. (2) In HYP patients, total/CV mortality increased with decreasing ABI categories: ABI <1.10-0.9: 4.5/1.3%, ABI <0.9-0.7: 7.6/3.7%, ABI <0.7-0.5: 15.9/7.1%, ABI <0.5: 27.5/17.5%.

(2) Similarly, non-fatal CV events were substantially increased in patients with HYP+ PAD (especially in low ABI categories). (3) In the Cox regression model, among the conventional CV risk factors, HYP at baseline was not associated with increased mortality in our study (Hazard Rate Ratio 0.9, 95% CI 0.8-1.2), while the strongest modifiable factors were current smoking (HRR 2.6, CI 1.9-3.6), PAD (HRR1.8, CI 1.5-2.3) and diabetes mellitus (1.7, CI: 1.4-2.1).

In conclusion, the combination of HYP + PAD is frequent in primary care and puts patients at substantially increased risk of death and CV morbidity. Screening of elderly patients for PAD is mandatory, and treatment intensity (with antihypertensives, antiplatelets etc.) should be optimized in those high risk patients.