Nina Dahle

Ambulatory blood pressure monitoring in outpatients with peripheral arterial disease and in general population

Peripheral arterial disease (PAD) is a common disease with high risk of cardiovascular morbidity and mortality. To enhance risk stratification and preventive treatment it is of interest to investigate the prognostic significance of ambulatory blood pressure measurement and prognostic biomarkers.

Cardiovascular (CV) disease remain the leading cause of morbidity and mortality worldwide. Elevated blood pressure (>140/90 mmHg) is very important among CV risk factors, accounting for almost 10 million deaths in 2015. Traditionally hypertension has been diagnosed using clinic blood pressure (BP) measurements but there is growing evidence that ambulatory blood pressure measurement (ABPM) is a stronger predictor of CV outcome and the use of ABPM is increasing. One of the most common clinical manifestations of systemic atherosclerosis is peripheral arterial disease (PAD) with narrowing of non-coronary arteries, mainly in lower limbs and carotids, and high prevalence of often silent concomitant coronary artery disease. PAD is a growing health problem, affecting approximately 20% of people over 60 years of age in Sweden and globally the prevalence is increasing. Since PAD is often asymptomatic (APAD) it may be underdiagnosed and as a result undertreated in primary care practice. PAD is associated with high risk of experiencing major CV events (MACE) and significant increased risk of CV mortality. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

The overall aim is to evaluate the pathophysiology and clinical utility of ambulatory blood pressure monitoring in outpatients with PAD and in general population, and to investigate the possibility to use prognostic biomarkers in risk reduction.

The cohort used in this thesis for prospective cohort studies and cross-sectional studies consists of in total 452 included patients, consecutively referred to the outpatient vascular surgery department at Västmanlands hospital in Västerås for clinical evaluation and vascular ultrasound examination from April 2006 to February 2011. The recruited patients are followed from index examination and events are detected through linkage to the Swedish National Population Cause-of-Death and National In-patient registries. The analyses will be performed using SPSS and R version 3.4.3 (R Foundation for Statistical Computing, Vienna, Austria).

Hopefully this study can contribute to a better awareness of patients with PAD and to increased knowledge of how to best use the resorce ambulatory blood pressure monitoring.

Uppsala University

Supervisor: Pär Hedberg, associate professor, chief physician department of Clinical Physiology, Västmanlands sjukhus Västerås and Centre of Clinical Research, Uppsala university