What is Peripheral Artery Disease (PAD)? Know how it is linked with hypertension

New Delhi:

Peripheral arterial disease (PAD) means blockage in the blood supply to the leg caused by cholesterol deposition and clotting. Hypertension, or high blood pressure, is closely interlinked with PAD, and both share common risk factors such as diabetes, sedentary lifestyle, obesity, sleep apnoea, chronic kidney disease, age, and smoking.

According to Dr Sunil Dwivedi, Consultant Cardiologist, Manipal Hospital, about one-third of patients with peripheral artery disease will also have hypertension. Furthermore, the worse the clinical manifestation of PAD, the higher the blood pressure tends to be. In most cases, high blood pressure not only contributes to the development of PAD but can also increase its severity by damaging the walls of the arteries, leading to more calcium and cholesterol deposits, as well as clot formation.

Patients with both PAD and hypertension do not only experience leg problems such as intermittent claudication, leg pain, and the development of ulcers and gangrene. They are also more prone to serious complications, including stroke, kidney failure, and heart attack, because the same pathology affects other organs.

Good control of hypertension after diagnosis, combined with comprehensive lifestyle management and maintaining blood pressure below 130/80 mmHg with the help of medications, helps reduce the occurrence and progression of peripheral artery disease.

Clinical manifestations of Peripheral Artery Disease

• Acute Peripheral Artery Disease: This is acute ischaemia of the leg occurring within two weeks. It is a threatening condition for the affected limb that, if untreated, can rapidly lead to amputation or even death.
• Chronic Peripheral Artery Disease: This is classified into:
• Chronic asymptomatic: where the disease is found during clinical examination or tests without symptoms.
• Chronic symptomatic: a stable condition with ongoing symptoms.
• Chronic worsening: a rapidly deteriorating condition, often accompanied by rest pain.

Diagnosis of PAD

Diagnosis usually begins with clinical examination—primarily palpation of peripheral pulses and measuring the Ankle Brachial Index (ABI). An ABI less than 0.9 is abnormal and indicates the need for further testing.

Common diagnostic tests include:

1. Non-invasive tests:

· Ultrasound Doppler (simple and commonly used)

· CT angiography for detailed imaging

2. Invasive tests:

· Angiography, the most definitive method

Treatment for PAD

• Medical management focuses on blood pressure control, ideally keeping it below 130/80 mmHg. It’s important to note that reducing blood pressure below 120/70 mmHg has not shown significant extra benefit.
• Managing cholesterol levels
• Smoking cessation
• Use of blood thinners, including cilostazol, which is important for symptom control
• If symptoms persist despite medical treatment, surgical or non-surgical endovascular treatments such as balloon angioplasty or stenting are considered and often yield satisfying results.

Importance of screening in hypertensive patients

Early detection is crucial. In any hypertensive patient, checking for peripheral artery disease during clinical examination is essential. This raises suspicion and allows for early diagnosis and treatment, which can prevent the development of PAD or manage it effectively if already present.

Disclaimer: (Tips and suggestions mentioned in the article are for general information only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.)

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