Low admission blood pressure as a marker of poor 1-year survival in patients with revascularized critical limb ischemia

Abstract

Objective: To contrast the association between blood pressure (BP) level and antihypertensive medications at hospital admission with 1-year mortality in patients undergoing revascularization for critical limb ischemia (CLI).Methods: From November 2013 to May 2019, 315 consecutive patients were retrospectively included. A median of seven (IQR 3-13) separate readings were recorded for each patient before revascularization procedure and the average represented patient's mean BP. BP-lowering medications, clinical and biological parameters were recorded at baseline. The main outcome was total 1year mortality. Results:The cohort included 172 men (55%) and 143 women (45%), with a mean age of 77.9 AE 11.9 years. Treated hypertension was present in 245 (78%) patients; 288 (91%) patients had BP-lowering drug prescriptions (2.1 AE 1.3 medications at baseline). Mean SBP, DBP, mean BP (MBP) and pulse pressure (PP) were 132 AE 18, 70 AE 8, 90 AE 10 and 62 AE 16mmHg. During 1-year follow-up, 80 (25.4%) patients died. In single-pressure multivariate analysis, SBP (hazard ratio 0.97; 95% CI 0.96-0.99; P ¼ 0.005), MBP (hazard ratio 0.96; 95% CI 0.92-0.99; P ¼ 0.01), PP (hazard ratio 0.97; 95% CI 0.95-0.99; P ¼ 0.009), but not DBP, were inversely correlated with 1year mortality, independently of age, coronary heart disease, left ventricular ejection fraction, brain natriuretic peptide, serum albumin, institutionalized status and antihypertensive drugs. Association between SBP, MBP and PP with 1-year mortality had a quite linear reverse pattern.Conclusion: Among patients undergoing revascularization for CLI, there is an inverse correlation between admission SBP, MBP and PP with 1-year mortality. BP may represent a modifiable therapeutic target to prevent poor outcome in CLI patients.

Peripheral arterial disease and hypertension

“…Another retrospective study examined the impact of BP on mortality in 315 patients with CLI undergoing revascularization and found an inverse relationship with SBP and mortality at 1 year (HR 0.97 [95% CI 0.95–0.99], P = 0.005). Similarly, an inverse relationship was found with mean BP and PP and mortality but not DBP [56 ▪ ]. Finally, another retrospective study of 165 patients undergoing below knee interventions for CLI found no difference in the incidence of mortality, target lesion revascularization, target extremity revascularization, and limb salvage rate, but an increased amputation rate in patients with controlled BP vs. uncontrolled BP defined as >140/90 (33.9 vs. 19.6%, P = 0.045) [57].…”