1. ¹Department of Cardiology, Karolinska Hospital, Sweden
2. ²Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
3. ³Department of Clinical Physiology, Karolinska Hospital, Sweden
4. ⁴Department of Medicine, Division of Emergency Medicine, Karolinska Hospital, Sweden

Correspondence: Dr P Svensson, Department of Cardiology, Karolinska Hospital, Stockholm, S-171 76, Sweden. E-mail: per.svensson@ks.se

Received 29 April 2003; Revised 14 July 2003; Accepted 24 August 2003.

Abstract

Patients with peripheral arterial disease (PAD) constitute a subgroup of high-risk hypertensives, but controlled studies on 24-h blood pressure (BP) and diurnal variation of BP are lacking. This study was performed in order to test the hypothesis that office BP (OBP) may underestimate 24-h BP in PAD patients in comparison to a matched control group. In all, 98 male patients (mean age 68 years) with a history of intermittent claudication and an ankle/brachial index less than 0.9, and 94 controls matched for age but without PAD or ischaemic heart disease performed 24-h recordings of ambulatory BP. A total of 59 patients had a history of hypertension and 69 were on treatment with BP-lowering drugs as compared to 17 and 23 of the control subjects, respectively. Office as well as 24-h systolic BP (SBP) were higher in patients as compared to controls (15122 vs 14020 mmHg, P<0.001 and 14214 vs 13315 mmHg, P<0.001, respectively), but did not differ with regard to diastolic BP. In an analysis of covariance with the continuous factors age, office SBP and the categorical factor antihypertensive treatment, 24-h SBP was higher in PAD patients compared to controls (P<0.05). The difference between office and night SBP was lower in PAD patients with antihypertensive treatment compared to controls (P=0.01). In conclusion, Male patients with PAD had higher systolic but not diastolic BP than age-matched control subjects. In PAD patients, 24-h SBP was higher than expected from OBP compared to controls. Night SBP was higher only in patients with antihypertensive treatment. In PAD patients, especially when on antihypertensive treatment, the severity of hypertension may be underestimated when based on OBP only.