The Very High Risk of Death and Heart Attack in Patients with Leg Artery Disease is Reduced by Intensive Blood Pressure Control
As the figure above shows, the worse arterial blockage is, the higher the risk of cardiovascular events and death. This study investigated the difference in outcomes related to blood pressure control in people with diabetes and arterial disease in the legs. In patients with intensive blood pressure control to an average top number of 128 vs. 137, the risk of an event was not increased, even in patients with the worst arterial blockage, and was the same as in a patient without leg arterial disease. However, in patients with leg arterial disease, 13.6% of people with intensive blood pressure treatment had cardiovascular events versus 38.7% in the moderate blood pressure treatment arm
That is a really remarkable finding that supports the new BP goal of 130/80 in diabetes and other high-risk patients. It is also worth pointing out that 130/80 was the goal in all the optimal medical therapy studies in diabetes and cardiovascular disease. Our goal should be to get blood pressure under 130/80 to protect our diabetic patients.
The severity of leg artery disease is closely correlated with the risk of heart attack, stroke, and death from vascular causes. Patients having the worst leg artery disease, such as those with high risk of amputation, have a very bad health future, with an annual death rate that exceeds 20%. This is because patients with amputation have microvascular disease which also impacts the heart, kidneys, nerves, and eyes. This study showed that in people with diabetes and “normal” blood pressure, the relationship between worse leg artery disease and more cardiovascular events was eliminated with lowering blood pressure to less than 130 on the top number.
It also matters how the blood pressure is controlled. In this same trial, researchers found that nisoldipine (similar to the calcium channel blocker amlodipine) was associated with a higher incidence of heart attacks (25) than enalapril (similar to lisinopril) (5). They showed that more aggressive blood pressure control in type 2 diabetic patients with “normal” blood pressure had a beneficial effect on protein in the urine, eye damage, and strokes, regardless of whether an ACE inhibitor or a calcium channel blocker was used as the initial antihypertensive agent.
The great results in this study are due to the aggressive blood pressure targets and the drugs that were used to control the pressure. Both nisoldipine and enalapril are antioxidants that work to interfere with the molecular signaling that causes high blood pressure, arterial disease, and cardiovascular events like heart attack and stroke. It is not a matter of either or. It is a matter of what combinations of medicines to control high blood pressure protect cells and organs most effectively.
We combine ACE inhibitors or ARBS, amlodipine, and spironolactone with a diuretic in our protocol. Very often all four medications are needed to achieve a blood pressure of less than 130. That is part of the reason results with optimal medical therapy are so much better. Let’s provide these more effective treatments for our patients.
I have treated some very severe PVD cases *several hundreds" by pushing them to walk in pain and push as many steps as they can tolerate each session, ketogenic eating and intermittent fasting. They do very well. Many of them came to me with a high probability of foot ulcers risking amoutations. My methods not only saved their limbs and but also lowered their Insulin doses required! No limb needed to be amputated under my watch!