Prevalence and correlates of lower extremity arerial disease in hypertensive patient with carotid atherosclerosis: Baseline results from the Multicenter Isradipine/Diuretic Atherosclerosis Study (MIDAS)

We determined the prevalence and correlates of symptomatic and asymptomatic peripheral arterial disease (PAD) in hypertensive subjects with carotid atherosclerosis documented by B-mode ultrasound. Cross-sectional analysis was performed in 371 participants enrolled in the Multicenter Isradipine/Diuretic Atherosclerosis Study (MIDAS) who had an evaluation for PAD using blood-pressure-measured ankle:brachial indices (ABI) and the Rose claudication questionnaire. The prevalence of PAD (ABI < 0.90) was 6.2%. All subjects but one were asymptomatic. PAD was univariately associated with age (62.3 vs. 57.7 years), systolic blood pressure (160.3 vs. 149.7 mmHg), diastolic blood pressure (98.7 vs. 96.4 mm Hg), HDL cholesterol (54.8 vs. 48.0 mg/dl), duration of hypertension (14.3 vs. 10.3 years), female gender (odds ratio [OR] = 4.54), and nonwhite race (OR = 9.05). There was a trend toward an association with mean carotid plaque thickness (1.23 vs. 1.17 mm) and history of angina (OR = 2.85). A stepwise logistic regression model demonstrated that age, nonwhite race, female gender, current smokers, and mean maximum carotid plaque thickness were predictors of the presence of PAD. PAD in subjects with hypertension and mild carotid atherosclerosis is common and usually asymptomatic. Nonwhite subjects who currently smoke and have a greater extent of carotid artery plaque are at increased odds of having coexisting lower extremity PAD. Use of blood-pressure-measured ABI can provide early detection of PAD in these patients.