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(Circulation. 2003;107:753.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Intensive Blood Pressure Control Reduces the Risk of Cardiovascular Events in Patients With Peripheral Arterial Disease and Type 2 Diabetes

Philip S. Mehler, MD; Joseph R. Coll, PhD; Raymond Estacio, MD; Anne Esler, PhD; Robert W. Schrier, MD; William R. Hiatt, MD

From Internal Medicine at Denver Health and Hospitals (P.S.M., R.E.), the Colorado Prevention Center (P.S.M., J.R.C., R.E., A.E., R.W.S., W.R.H.), Department of Medicine (A.E., R.W.S.), and the Section of Vascular Medicine, Divisions of Cardiology and Geriatrics (W.R.H.), University of Colorado Health Sciences Center, Denver.

Correspondence and reprint requests to William R. Hiatt, MD, Novartis Foundation Professor of Cardiovascular Research, University of Colorado Health Sciences Center, C/O Colorado Prevention Center, 789 Sherman St, Suite 200, Denver, CO 80203. E-mail Will.Hiatt{at}UCHSC.edu

Background— Peripheral arterial disease (PAD) and diabetes are both associated with a high risk of ischemic events, but the role of intensive blood pressure control in PAD has not been established.

Methods and Results— The Appropriate Blood Pressure Control in Diabetes study followed 950 subjects with type 2 diabetes for 5 years; 480 of the subjects were normotensive (baseline diastolic blood pressure of 80 to 89 mm Hg). Patients randomized to placebo (moderate blood pressure control) had a mean blood pressure of 137±0.7/81±0.3 mm Hg over the last 4 years of treatment. In contrast, patients randomized to intensive treatment with enalapril or nisoldipine had a mean 4-year blood pressure of 128±0.8/75±0.3 mm Hg (P<0.0001 compared with moderate control). PAD, which is defined as an ankle-brachial index <0.90 at the baseline visit, was diagnosed in 53 patients. In patients with PAD, there were 3 cardiovascular events (13.6%) on intensive treatment compared with 12 events (38.7%) on moderate treatment (P=0.046). After adjustment for multiple cardiovascular risk factors, an inverse relationship between ankle-brachial index and cardiovascular events was observed with moderate treatment (P=0.009), but not with intensive treatment (P=0.91). Thus, with intensive blood pressure control, the risk of an event was not increased, even at the lowest ankle-brachial index values, and was the same as in a patient without PAD.

Conclusions— In PAD patients with diabetes, intensive blood pressure lowering to a mean of 128/75 mm Hg resulted in a marked reduction in cardiovascular events.

Key Words: diabetes mellitus • hypertension • peripheral vascular disease

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