THE PREVALENCE OF PERIPHERAL ARTERIAL DISEASE IN ADULT HYPERTENSIVE PATIENTS IN NNEWI NIGERIA

Abstract

Peripheral arterial disease [PAD] is usually due to atherosclerosis
obliterans of the arteries of the lower limbs. It has a spectrum of
manifestations from the sub-clinical asymptomatic disease to symptomatic
disease with classic intermittent claudication. Most patients with PAD has
asymptomatic disease. All patients with PAD are at increased risk of
morbidity and mortality from major cardiovascular events such as
myocardial infarction and stroke.
Prevalence of PAD varies from region to region. In Nigeria, data on
prevalence of PAD is very scanty. This study therefore aims to determine the
prevalence of PAD in adult Nigerian hypertensive patients .
Between August to December 2004, two hundred and fifty hypertensive
patients, (one hundred and fifty with only hypertension, and one hundred
with hypertension and co-existent diabetes mellitus) were screened for PAD.
They were aged 18 years and above, with a mean peak age of 58.94 years.
106 [42.5%] were males while 144 [57.6%] were females. Eighty age and
sex-matched controls were also screened, and they had a mean
age of 58.8 years. Rose intermittent claudication questionnaire was
interviewer-administered. Physical examination, and Doppler studies were
carried out on each patient. Colometric estimation of total cholesterol,
HDL-cholesterol, LDL-cholesterol, and triglycerides were done. Fasting
blood glucose estimation was also done.
Results show that PAD has an overall prevalence of 24.8% in the
study group. Most patients were asymptomatic and the ratio of
symptomatic to asymptomatic disease was found to be 1: 3.4. Patients with
concurrent diabetes had relatively higher prevalence rate [26%] compared to
patients with only hypertension [24%]. Also lipid derangement was higher in
patients with PAD than in those without PAD.
Prevalence was much higher in patients above 55 years of age
[30.7%] than in patients below 55years of age [15.5%]. Highest prevalence
rate was detected using the ankle-brachial index [ABI] (24.8%), followed by
physical examination (10%), and lastly by anamnesis (5.6%).

It is concluded that PAD appears to be common in our hypertensive patients
than was previously believed, with majority of the patients being
asymptomatic. Lipid derangement was also higher in patients with PAD.