ABSTRACT Peripheral vascular disease (PVD) is associated with a high cardiovascular morbidity and mortality. Intermittent claudication is the most common symptomatic manifestation of PVD,

but is also an important predictor of cardiovascular death, increasing it by three-fold, and increasing all-cause mortality by two to five-fold. Hypertension is a common and important risk

factor for vascular disorders, including PVD. Of hypertensives at presentation, about 2–5% have intermittent claudication, with this prevalence increasing with age. Similarly, 35–55% of

patients with PVD at presentation also have hypertension. Patients who suffer from hypertension with PVD have a greatly increased risk of myocardial infarction and stroke. Apart from the

addressed whether a reduction in blood pressure causes a decrease in PVD incidence. There is therefore an obvious need for such outcome studies, especially since the two conditions are

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PERIPHERAL ARTERY DISEASE COMPARED TO CORONARY, CEREBRAL AND CAROTID ARTERY Article Open access 31 January 2025 REFERENCES * Kannel WB The demographics of claudication and the aging of the

American population _Vasc Med_ 1996 1 60–64 CAS  PubMed  Google Scholar  * Reunanen A, Takkunen H, Aromaa A Prevalence of intermittent claudication and its effect on mortality _Acta Med

Scand_ 1982 211 249–256 CAS  PubMed  Google Scholar  * Bowlin SJ _et al_Intermittent claudication in 8343 men and 21-year specific mortality follow-up _Ann Epidemiol_ 1997 7 180–187 CAS 

PubMed  Google Scholar  * Fowkes FG _et al_Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the

Edinburgh Artery Study _Am J Epidemiol_ 1992 135 331–340 CAS  PubMed  Google Scholar  * Kannel WB Role of blood pressure in cardiovascular morbidity and mortality _Prog Cardiovasc Dis_ 1974

17 5–24 CAS  PubMed  Google Scholar  * Ramsay LE Intermittent claudication in hypertensive men _J R Coll Physicians Lond_ 1979 13 100–102 CAS  PubMed  PubMed Central  Google Scholar  *

Binaghi F _et al_Prevalence of peripheral arterial occlusive disease and associated risk factors in a sample of southern Sardinian population _Int Angiol_ 1994 13 233–245 CAS  PubMed  Google

Scholar  * Cheng SW, Ting AC, Lau H, Wong J Epidemiology of atherosclerotic peripheral arterial occlusive disease in Hong Kong _World J Surg_ 1999 23 202–206 CAS  PubMed  Google Scholar  *

Johnston KW _et al_An atherosclerosis risk factor assessment program forpatients with peripheral arterial occlusive disease _Ann Vasc Surg_ 1988 2 101–107 CAS  PubMed  Google Scholar  * Novo

S _et al_Prevalence of risk factors inpatients with peripheral arterial disease. A clinical and epidemiological evaluation _Int Angiol_ 1992 11 218–229 CAS  PubMed  Google Scholar  * Violi

F, Criqui M, Longoni A, Castiglioni C Relation between risk factors and cardiovascular complications inpatients with peripheral vascular disease. Results from the A.D.E.P. study

_Atherosclerosis_ 1996 120 25–35 CAS  PubMed  Google Scholar  * Bauwens F _et al_Localisation and risk factors of peripheral arterial occlusive disease in the female _Int Angiol_ 1989 8

32–35 CAS  PubMed  Google Scholar  * McGill HC,Jr _et al_Relation of a postmortem renal index of hypertension to atherosclerosis and coronary artery size in young men and women.

Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group _Arterioscler Thromb Vasc Biol_ 1998 18 1108–1118 PubMed  Google Scholar  * Simon AC _et al_Evidence of early

changes of the brachial artery circulation in borderline hypertension _J Cardiovasc Pharmacol_ 1986 8 (SUPPL 5) S36–S38 Google Scholar  * Criqui MH _et al_The prevalence of peripheral

arterial disease in a defined population _Circulation_ 1985 71 510–515 CAS  PubMed  Google Scholar  * Criqui MH _et al_ _Peripheral arterial disease and hypertension. In: Izzo JL, Black HR

(eds). Hypertension Primer_ Lippincott, Williams and Wilkins: Dallas 1999; pp 215–217 Google Scholar  * Meijer WT _et al_Peripheral arterial disease in the elderly: The Rotterdam Study

_Arterioscler Thromb Vasc Biol_ 1998 18 185–192 CAS  PubMed  Google Scholar  * Hooi JD _et al_Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial

occlusive disease. The Limburg PAOD Study. Peripheral Arterial Occlusive Disease _Scand J Prim Health Care_ 1998 16 177–182 CAS  PubMed  Google Scholar  * Bowlin SJ _et al_Epidemiology of

intermittent claudication in middle-aged men _Am J Epidemiol_ 1994 140 418–430 CAS  PubMed  Google Scholar  * Management of peripheral arterial disease (PAD) TransAtlantic Inter-Society

Consensus (TASC) _Eur J Vasc Endovasc Surg_ 2000 19 (SUPPL A) S1-S250 Google Scholar  * Dagenais GR _et al_Intermittent claudication in Quebec men from 1974–1986: the Quebec Cardiovascular

Study _Clin Invest Med_ 1991 14 93–100 CAS  PubMed  Google Scholar  * Murabito JM, D’Agostino RB, Silbershatz H, Wilson WF Intermittent claudication. A risk profile from The Framingham Heart

Study _Circulation_ 1997 96 44–49 CAS  PubMed  Google Scholar  * Gubner RS Systolic hypertension: a pathogenic entity _Am J Cardiol_ 1962 9 773–776 CAS  PubMed  Google Scholar  * Waller PC

_et al_Does therapeutic reduction of diastolic blood pressure cause death from coronary heart disease? _J Hum Hypertens_ 1988 2 7–10 CAS  PubMed  Google Scholar  * Isles CG _et al_Mortality

inpatients of the Glasgow Blood Pressure Clinic _J Hypertens_ 1986 4 141–156 CAS  PubMed  Google Scholar  * Lever AF _et al_Mortality amongstpatients of the Glasgow Blood Pressure Clinic was

high in the 1970s and 80s but has fallen since, why? _Clin Exp Hypertens_ 1999 21 553–562 CAS  PubMed  Google Scholar  * Kannel WB, McGee DL Update on some epidemiologic features of

intermittent claudication: the Framingham Study _J Am Geriatr Soc_ 1985 33 13–18 CAS  PubMed  Google Scholar  * Kannel WB, Skinner JJ, Jr, Schwartz MJ, Shurtleff D. Intermittent

claudication. Incidence in the Framingham Study _Circulation_ 1970 41 875–883 CAS  PubMed  Google Scholar  * McGill HC, Jr _et al_. Relation of a postmortem renal index of hypertension to

atherosclerosis in youth _Arterioscler Thromb Vasc Biol_ 1995 15 2222–2228 PubMed  Google Scholar  * Ingolfsson IO _et al_A marked decline in the prevalence and incidence of intermittent

claudication in Icelandic men 1968–1986: a strong relationship to smoking and serum cholesterol – the Reykjavik Study _J Clin Epidemiol_ 1994 47 1237–1243 CAS  PubMed  Google Scholar  *

Newman AB, Tyrrell KS, Kuller LH Mortality over four years in SHEP participants with a low ankle-arm index _J Am Geriatr Soc_ 1997 45 1472–1478 CAS  PubMed  Google Scholar  * Lederle FA _et

al_Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group _Ann Intern Med_

1997 126 441–449 CAS  PubMed  Google Scholar  * Englund R, Hudson P, Hanel K, Stanton A Expansion rates of small abdominal aortic aneurysms _Aust N Z J Surg_ 1998 68 21–24 CAS  PubMed 

Google Scholar  * Harding MB, Smith LR Renal artery stenosis: prevalence and associated risk factors inpatients undergoing routine cardiac catheterisation _J Am Soc Nephrol_ 1992 2 1608–1616

CAS  PubMed  Google Scholar  * Missouris CG, Buckenham T, Cappuccio FP, MacGregor GA Renal artery stenosis: a common and important problem inpatients with peripheral vascular disease _Am J

Med_ 1994 96 10–14 CAS  PubMed  Google Scholar  * Wachtell K _et al_Prevalence of renal artery stenosis inpatients with peripheral vascular disease and hypertension _J Hum Hypertens_ 1996 10

83–85 CAS  PubMed  Google Scholar  * Ramsay LE Blood pressure response to percutaneous angioplasty for renovascular hypertension: an overview of published series _BMJ_ 1990 300 569–572 CAS

  PubMed  PubMed Central  Google Scholar  * Harden PN, MacLeod MJ Effect of renal artery stenting on progression of renovascular renal failure _Lancet_ 1997 349 1133–1136 CAS  PubMed  Google

Scholar  * van Jaarsveld BC _et al_The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study

Group _N Engl J Med_ 2000 342 1007–1014 CAS  PubMed  Google Scholar  * Choudhri AH _et al_Unsuspected renal artery stenosis in peripheral vascular disease _BMJ_ 1990 301 1197–1198 CAS 

PubMed  PubMed Central  Google Scholar  * Alcolado JC, Pacy PJ, Beevers M, Dodson PM Risk factors for peripheral vascular disease in hypertensive subjects with type 2 diabetes mellitus

_Diabet Med_ 1992 9 904–907 CAS  PubMed  Google Scholar  * Hoy W, Light A, Megill D Blood pressure in Navajo Indians and its association with type 2 diabetes and renal and cardiovascular

disease _Am J Hypertens_ 1994 7 321–328 CAS  PubMed  Google Scholar  * Tseng CH _et al_Atherosclerotic risk factors for peripheral vascular disease in non-insulin-dependent diabeticpatients

_J Formos Med Assoc_ 1994 93 663–667 CAS  PubMed  Google Scholar  * Janka HU, Standl E, Mehnert H Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk

factors: screening with the doppler ultrasonic technique _Diabetes Care_ 1980 3 207–213 CAS  PubMed  Google Scholar  * Migdalis IN _et al_Peripheral vascular disease in newly diagnosed

non-insulin-dependent diabetic _Int Angiol_ 1992 11 230–232 CAS  PubMed  Google Scholar  * Palumbo PJ _et al_Progression of peripheral occlusive arterial disease in diabetes mellitus _What

factors are predictive? Arch Intern Med_ 1991 151 717–721 CAS  PubMed  Google Scholar  * Jones CJ _et al_Abnormal arterial flow pattern in untreated essential hypertension: possible link

with the development of atherosclerosis _Clin Sci (Colch)_ 1990 78 431–435 CAS  Google Scholar  * Steinberg D _et al_Beyond cholesterol. Modifications of low-density lipoprotein that

increase its atherogenicity _N Engl J Med_ 1989 320 915–924 CAS  PubMed  Google Scholar  * Witztum JL Role of oxidised low density lipoprotein in atherogenesis _Br Heart J_ 1993 69 S12–S18

CAS  PubMed  PubMed Central  Google Scholar  * Aqel NM, Ball RY, Waldmann H, Mitchinson MJ Identification of macrophages and smooth muscle cells in human atherosclerosis using monoclonal

antibodies _J Pathol_ 1985 146 197–204 CAS  PubMed  Google Scholar  * Ross R The pathogenesis of atherosclerosis-an update _N Engl J Med_ 1986 314 488–500 CAS  PubMed  Google Scholar  *

Nakazawa T, Yasuhara H, Shigematsu K, Shigematsu H Platelet-induced migration of smooth muscle cells under shear stress _Microvasc Res_ 1999 58 177–182 CAS  PubMed  Google Scholar  * Lip GY,

Blann AD Does hypertension confer a prothrombotic state? Virchow’s triad revisited [editorial; comment] _Circulation_ 2000 101 218–220 CAS  PubMed  Google Scholar  * Riondino S _et

al_Platelet hyperactivity in hypertensive olderpatients is controlled by lowering blood pressure _J Am Geriatr Soc_ 1999 47 943–947 CAS  PubMed  Google Scholar  * Lip GY, Lowe GD, Rumley A,

Dunn FG Fibrinogen and fibrin D-dimer levels in paroxysmal atrial fibrillation: evidence for intermediate elevated levels of intravascular thrombogenesis _Am Heart J_ 1996 131 724–730 CAS 

PubMed  Google Scholar  * Smith FB _et al_Smoking, haemostatic factors and lipid peroxides in a population case control study of peripheral arterial disease _Atherosclerosis_ 1993 102

155–162 CAS  PubMed  Google Scholar  * Salomaa V _et al_Association of fibrinolytic parameters with early atherosclerosis _Circulation_ 1995 91 284–290 CAS  PubMed  Google Scholar  * Fowkes

FG _et al_Cross-linked fibrin degradation products, progression of peripheral arterial disease, and risk of coronary heart disease _Lancet_ 1993 342 84–86 CAS  PubMed  Google Scholar  * Lowe

GD _et al_Fibrin D-dimer, Von Willebrand factor and tissue plasminogen activator antigens are predictors of major ischaemic heart disease: the Caerphilly study _Blood Coagul Fibrinolysis_

1995 6 156–157 Google Scholar  * Cook PJ, Lip GY Infectious agents and atherosclerotic vascular disease _QJM_ 1996 89 727–735 CAS  PubMed  Google Scholar  * Cook PJ _et al_Chlamydia

pneumoniae antibodies in severe essential hypertension _Hypertension_ 1998 31 589–594 CAS  PubMed  Google Scholar  * Ramsay L _et al_Guidelines for management of hypertension: report of the

third working party of the British Hypertension Society _J Hum Hypertens_ 1999 13 569–592 CAS  PubMed  Google Scholar  * Schweizer J, Kaulen R, Nierade A, Altmann E Beta-blockers and

nitrates inpatients with peripheral arterial occlusive disease: long-term findings _Vasa_ 1997 26 43–46 CAS  PubMed  Google Scholar  * Solomon SA _et al_Beta blockade and intermittent

claudication: placebo controlled trial of atenolol and nifedipine and their combination _BMJ_ 1991 303 1100–1104 CAS  PubMed  PubMed Central  Google Scholar  * Radack K, Deck C

Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. A meta-analysis of randomized controlled trials _Arch Intern Med_ 1991

151 1769–1776 CAS  PubMed  Google Scholar  * Heintzen MP, Strauer BE Peripheral vascular effects of beta-blockers _Eur Heart J_ 1994 15 (SUPPL C) 2–7 Google Scholar  * Breckenridge A,

Roberts D, Walley T Different vasodilating mechanisms-different peripheral effects? _J Cardiovasc Pharmacol_ 1992 19 (SUPPL 1) S23–S26 Google Scholar  * Libretti A, Catalano M Captopril in

the treatment of hypertension associated with claudication _Postgrad Med J_ 1986 62 (SUPPL 1) 34–37 Google Scholar  * Catalano M, Libretti A Captopril for the treatment ofpatients with

hypertension and peripheral vascular disease _Angiology_ 1985 36 293–6 CAS  PubMed  Google Scholar  * Yusuf S _et al_Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on

cardiovascular events in high-riskpatients. The Heart Outcomes Prevention Evaluation Study Investigators [Published errata appear in N Engl J Med 2000; 342: 748 and 2000; 342: 1376] _N Engl

J Med_ 2000 342 145–153 CAS  PubMed  Google Scholar  * Taylor SH Efficacy of doxazosin in specific hypertensivepatient groups _Am Heart J_ 1991 121 286–292 CAS  PubMed  Google Scholar  *

Rosendorff C Indoramin in the hypertensivepatient with concomitant disease: clinical experience _J Cardiovasc Pharmacol_ 1986 8 (SUPPL 2) S93–S97 Google Scholar  * Liu Y _et al_Effect of

felodipine on regional blood supply and collateral vascular resistance inpatients with peripheral arterial occlusive disease _Vasc Med_ 1997 2 13–18 CAS  PubMed  Google Scholar  * Bagger JP

_et al_Effect of verapamil in intermittent claudication A randomized, double-blind, placebo-controlled, cross-over study after individual dose-response assessment _Circulation_ 1997 95

411–414 CAS  PubMed  Google Scholar  * Morgan RH _et al_The effects of nifedipine on blood flow in peripheral vascular disease of the lower limbs _Eur Heart J_ 1987 8 (SUPPL K) 87–91 Google

Scholar  * Bernardi D _et al_Assessment of captopril and nicardipine effects on chronic occlusive arterial disease of the lower extremity using Doppler ultrasound _Angiology_ 1988 39 942–952

CAS  PubMed  Google Scholar  * Emanuel MB Specific calcium antagonists in the treatment of peripheral vascular disease _Angiology_ 1979 30 454–469 CAS  PubMed  Google Scholar  *

Sutton-Tyrrell K _et al_Morbidity, mortality, and antihypertensive treatment effects by extent of atherosclerosis in older adults with isolated systolic hypertension _Stroke_ 1995 26

1319–1324 CAS  PubMed  Google Scholar  * Schiffrin EL, Deng LY Relationship between small-artery structure and systolic, diastolic and pulse pressure in essential hypertension _J Hypertens_

1999 17 381–387 CAS  PubMed  Google Scholar  * Schiffrin EL, Park JB, Intengan HD, Touyz RM Correction of arterial structure and endothelial dysfunction in human essential hypertension by

the angiotensin receptor antagonist losartan _Circulation_ 2000 101 1653–1659 CAS  PubMed  Google Scholar  * Schiffrin EL, Deng LY Comparison of effects of angiotensin I-converting enzyme

inhibition and beta-blockade for 2 years on function of small arteries from hypertensivepatients _Hypertension_ 1995 25 699–703 CAS  PubMed  Google Scholar  * Fowkes FG _et al_Edinburgh

Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population _Int J Epidemiol_ 1991 20 384–392 CAS  PubMed  Google Scholar  * Vardulaki KA

_et al_Quantifying the risks of hypertension, age, sex and smoking inpatients with abdominal aortic aneurysm _Br J Surg_ 2000 87 195–200 CAS  PubMed  Google Scholar  * Spittell PC, Ehrsam

JE, Anderson L, Seward JB Screening for abdominal aortic aneurysm during transthoracic echocardiography in a hypertensivepatient population _J Am Soc Echocardiogr_ 1997 10 722–727 CAS 

PubMed  Google Scholar  * Lindholt JS, Henneberg EW, Fasting H, Juul S Mass or high-risk screening for abdominal aortic aneurysm _Br J Surg_ 1997 84 40–42 CAS  PubMed  Google Scholar  *

Williams IM _et al_Prevalence of abdominal aorticaneurysm in a hypertensive population _Ann R Coll Surg Engl_ 1996 78 501–504 CAS  PubMed  PubMed Central  Google Scholar  * Grimshaw GM,

Thompson JM, Hamer JD Prevalence of abdominal aortic aneurysm associated with hypertension in an urban population _J Med Screen_ 1994 1 226–228 CAS  PubMed  Google Scholar  Download

references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * University Department of Medicine, City Hospital, Birmingham, B18 7QH, UK A Makin, GYH Lip & DG Beevers * Department of Vascular

Surgery, City Hospital, Birmingham, B18 7QH, UK A Makin & S Silverman Authors * A Makin View author publications You can also search for this author inPubMed Google Scholar * GYH Lip

View author publications You can also search for this author inPubMed Google Scholar * S Silverman View author publications You can also search for this author inPubMed Google Scholar * DG

Beevers View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to GYH Lip. ADDITIONAL INFORMATION This paper was submitted

to and dealt with by the USA Office of the _Journal of Human Hypertension_. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Makin, A., Lip, G.,

Silverman, S. _et al._ Peripheral vascular disease and hypertension: a forgotten association?. _J Hum Hypertens_ 15, 447–454 (2001). https://doi.org/10.1038/sj.jhh.1001209 Download citation

* Received: 01 February 2001 * Revised: 06 February 2001 * Accepted: 20 February 2001 * Published: 18 July 2001 * Issue Date: 01 July 2001 * DOI: https://doi.org/10.1038/sj.jhh.1001209 SHARE

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clipboard Provided by the Springer Nature SharedIt content-sharing initiative KEYWORDS * hypertension * peripheral vascular disease * atherosclerosis