Angioplasty of Flow-Limiting Stenosis Reduces Aortic and Brachial Blood Pressure in Patients With Peripheral Artery Disease

Lucas Busch, Yvonne Heinen, Manuel Stern, Georg Wolff, Göksen Özaslan, Konstantina Tzetou, Roberto Sansone, Christian Heiss, Malte Kelm, Lucas Busch, Yvonne Heinen, Manuel Stern, Georg Wolff, Göksen Özaslan, Konstantina Tzetou, Roberto Sansone, Christian Heiss, Malte Kelm

Abstract

Background Arterial hypertension affects cardiovascular outcome in patients with peripheral artery disease (PAD). We hypothesized that angioplasty of peripheral arterial stenoses decreases aortic (aBP) and brachial blood pressure (bBP). Methods and Results In an index cohort (n=30), we simultaneously measured aBP, bBP, augmentation index (AIx), and aortic pulse wave velocity (PWV) before and after angioplasty of the iliac and femoropopliteal arteries; diagnostic angiography served as a control. In an all-comer registry cohort (n=381), we prospectively measured bBP in patients scheduled for angioplasty of the iliac, femoral, and crural arteries or diagnostic angiography. Systolic aBP decreased after iliac (Δ-25 mmHg; 95% CI, -30 to -20; P<0.0001) and femoropopliteal angioplasty (Δ-12 mmHg; 95% CI, -17 to -5; P<0.0001) as compared with diagnostic angiography. Diastolic aBP decreased after iliac (Δ-9 mmHg; 95% CI, -13 to -1; P=0.01) but not femoropopliteal angioplasty. In parallel, AIx significantly dropped, whereas PWV remained stable. In the registry cohort, systolic bBP decreased after angioplasty of the iliac (Δ-17 mmHg; 95% CI, -31 to -8; P=0.0005) and femoropopliteal arteries (Δ-10 mmHg; 95% CI, -23 to -1; P=0.04) but not the crural arteries, as compared with diagnostic angiography. Diastolic bBP decreased after iliac (Δ-10 mmHg; 95% CI, -17 to -2; P=0.01) and femoropopliteal angioplasty (Δ-9 mmHg; 95% CI, -15 to -1; P=0.04). Multivariate analysis identified baseline systolic bBP and site of lesion as determinants of systolic bBP drop after endovascular treatment. Conclusions Angioplasty of flow-limiting stenoses in patients with peripheral artery disease lowers aortic and brachial blood pressure with more pronounced effects at more proximal lesion sites and elevated baseline systolic blood pressure. These data indicate a role of endovascular treatment to acutely optimize blood pressure in patients with peripheral artery disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02728479.

Keywords: arterial hypertension; augmentation index; blood pressure; peripheral artery disease; pulse wave velocity.

Conflict of interest statement

None.

Figures

Figure 1. CONSORT diagram of the prospective…
Figure 1. CONSORT diagram of the prospective Duesseldorf percutaneous transluminal angioplasty study.
A, Index cohort with 30 patients. Clinical evaluations including office measurement of brachial blood pressure (bBP), ankle‐brachial index (ABI), heart rate (HR), and vascular assessment at baseline 1 day before and 1 day after intervention. Intraprocedural invasive serial hemodynamic measurement of segmental aortic blood pressure (aBP), augmentation index (AIx), pulse wave velocity (PWV), and bBP before and after angioplasty or diagnostic angiography. B, Registry cohort with office bBP recordings 1 day before and 1 day after angioplasty and angiography. Cath lab indicates catheterization laboratory; and Fempop., femoropopliteal.
Figure 2. Segmental, serial, invasive aortic blood…
Figure 2. Segmental, serial, invasive aortic blood pressure (aBP) measurements before and after endovascular treatment measured from proximal (A) to distal (D) sites of the aorta.
Bars indicate standard error of the mean. *P<0.05 vs baseline (paired t test). ■ indicates iliac angioplasty (n=15); ▲, femoropopliteal (fempop.) angioplasty (n=10); •, diagnostic angiography (n=5).
Figure 3. Physicomechanical properties of the aorta.
Figure 3. Physicomechanical properties of the aorta.
A, Aortic pulse wave velocity (PWV) before (black bars) and after (white bars) peripheral angioplasty of the iliac (n=15) femoropopliteal (fempop.) (n=10) arteries and during diagnostic angiography (n=5). B, Timing of the reflected pressure wave (T1) to the aorta before (black bars) and after (white bars) angioplasty or diagnostic angiography. C, Augmentation index (AIx) before (black bars) and after (white bars) elective angioplasty and diagnostic angiography. Bars indicate mean and standard error of the mean. *P<0.05 vs baseline (paired t test). %, &, and #, P<0.05 (1‐way ANOVA).
Figure 4. Relation of intraprocedural changes in…
Figure 4. Relation of intraprocedural changes in aortic blood pressure (aBP) and brachial blood pressure (bBP) before and after angioplasty.
A, Correlation of angioplasty‐associated changes in invasively measured systolic aBP (Δ systolic aBP) and systolic bBP (Δ systolic bBP) determined via sphygmometry. B, Correlation of changes in diastolic aBP (Δ diastolic aBP) and diastolic bBP (Δ diastolic bBP). ■ indicates iliac angioplasty (n=15); ▲, femoropopliteal angioplasty (n=10); and •, diagnostic angiography (n=5).
Figure 5. Endovascular treatment of iliacal and…
Figure 5. Endovascular treatment of iliacal and femoral flow‐limiting stenosis is associated with selective improvement/restitution of peripheral blood flow into the treated leg and reduction in brachial blood pressure (bBP) in the index cohort.
A, Heart rate (HR) measured at baseline 1 day before (black bars) and 1 day after (white bars) angioplasty of the iliac (n=15) and femoropopliteal (fempop.) (n=10) arteries, and after diagnostic angiography (n=5). B, Systolic bBP and diastolic bBP 1 day before (black bars) and 1 day after angioplasty (white bars) and diagnostic angiography. C, Common femoral artery (CFA) blood flow in the untreated leg 1 day before (black bars) and 1 day after (white bars) angioplasty of the contralateral leg. D, Target leg CFA blood flow 1 day before (black bars) and 1 day after (white bars) angioplasty and diagnostic angiography. Bars are mean and error bars are standard error of the mean. *P<0.05 vs baseline (paired t test). §, #, and &, P<0.05 (1‐way ANOVA).
Figure 6. Change in brachial blood pressure…
Figure 6. Change in brachial blood pressure (bBP) following angioplasty in the registry cohort.
Office systolic bBP (A) and diastolic bBP (B) at baseline as measured on the day before (black bars) and on the day after (white bars) elective angioplasty of iliac (n=119), femoropopliteal (fempop.) (n=208), and below‐the‐knee (BTK) (n=39) arteries. Bars indicate mean standard error of the mean. *P<0.05 vs baseline (paired t test). & and #, P<0.05 (1‐way ANOVA).

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