Artikel
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
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Veröffentlicht: | 8. August 2006 |
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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.