Journal of vascular surgery · 2025
Blood pressure parameters and the risk of chronic limb-threatening ischemia: The Singapore Chinese Health Study.
СтатьяПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Ying Ariel Fangting, Talaei Mohammad, Zhang Shan, Koh Woon-Puay
Аннотация
BACKGROUND: Although hypertension is an established risk factor for chronic limb-threatening ischemia (CLTI), little is known about how the individual blood pressure (BP) parameters could influence CLTI risk. We investigated associations of systolic BP, diastolic BP, and pulse pressure (PP) with CLTI risk in a prospective population-based cohort.
METHODS: We used data from the Singapore Chinese Health Study, involving 30,636 participants aged 46-85 years, with BP measured by trained interviewers during follow-up I interviews from 1999 to 2004. CLTI cases were identified via linkage to hospital records. Associations between various BP parameters and CLTI risk were examined via multivariable Cox models.
RESULTS: After a mean follow-up of 13.6 years, there were 407 incident CLTI cases. In individual models, all BP parameters were positively associated with CLTI risk in a stepwise manner. However, after pairwise adjustment for PP, systolic and diastolic BP were no longer associated with CLTI risk. Positive associations between different grades of hypertension and CLTI risk were also attenuated after adjusting for PP. Conversely, after adjustment for other BP parameters and vascular risk factors, PP remained independently associated with CLTI risk in a stepwise manner (P for trend ≤ .002). Compared with the lowest PP category (<40 mm Hg), the hazard ratio (95% confidence interval) was 5.24 (3.04-9.03) for the highest category (≥80 mm Hg).
CONCLUSIONS: Our study found that only PP remained independently associated with CLTI risk after adjusting for other BP parameters and provided a basis for targeting reduction of arterial stiffness to decrease CLTI risk.
METHODS: We used data from the Singapore Chinese Health Study, involving 30,636 participants aged 46-85 years, with BP measured by trained interviewers during follow-up I interviews from 1999 to 2004. CLTI cases were identified via linkage to hospital records. Associations between various BP parameters and CLTI risk were examined via multivariable Cox models.
RESULTS: After a mean follow-up of 13.6 years, there were 407 incident CLTI cases. In individual models, all BP parameters were positively associated with CLTI risk in a stepwise manner. However, after pairwise adjustment for PP, systolic and diastolic BP were no longer associated with CLTI risk. Positive associations between different grades of hypertension and CLTI risk were also attenuated after adjusting for PP. Conversely, after adjustment for other BP parameters and vascular risk factors, PP remained independently associated with CLTI risk in a stepwise manner (P for trend ≤ .002). Compared with the lowest PP category (<40 mm Hg), the hazard ratio (95% confidence interval) was 5.24 (3.04-9.03) for the highest category (≥80 mm Hg).
CONCLUSIONS: Our study found that only PP remained independently associated with CLTI risk after adjusting for other BP parameters and provided a basis for targeting reduction of arterial stiffness to decrease CLTI risk.