Impact of hypertension on arterial stiffness and cardiac autonomic modulation in patients with peripheral artery disease: a cross- sectional study

Objective: To examine the impact of hypertension on cardiovascular health in patients with symptomatic peripheral artery disease and to identify factors associated with uncontrolled hypertension. Methods: A cross-sectional study including 251 patients with symptomatic peripheral artery disease (63.9% males, mean age 67 +/- 10 years). Following hypertension diagnosis, blood pressure was measured to determine control of hypertension. Arterial stiffness (carotid-femoral pulse wave velocity) and cardiac autonomic modulation (sympathovagal balance) were assessed. Results: Hypertension was associated with higher carotid-femoral pulse wave velocity, regardless of sex, age, ankle-brachial index, body mass index, walking capacity, heart rate, or comorbidities (beta=2.59 +/- 0.76m/s, b=0.318, p=0.003). Patients with systolic blood pressure <= 120mmHg had higher carotid-femoral pulse wave velocity values than normotensive individuals, and hypertensive patients with systolic blood pressure of <= 119mmHg (normotensive: 7.6 +/- 2.4m/s=<= 119mmHg: 8.1 +/- 2.2m/s 120-129mmHg: 9.8 +/- 2.6m/s=>= 130mmHg: 9.9 +/- 2.9m/s, p<0.005). Sympathovagal balance was not associated with hypertension (p>0.05). Conclusion: Hypertensive patients with symptomatic peripheral artery disease have increased arterial stiffness. Arterial stiffness is even greater in patients with uncontrolled high blood pressure.