title: Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults.
abstract: OBJECTIVE
  To determine the subgroup specific associations between usual blood pressure and risk of peripheral arterial disease, and to examine the relation between peripheral arterial disease and a range of other types of vascular disease in a large contemporary cohort.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Linked electronic health records from 1990 to 2013 in the United Kingdom.
  
  
  METHODS
  4,222,459 people aged 30-90 years, registered at a primary care practice for at least one year and with a blood pressure measurement.
  
  
  METHODS
  Time to first diagnosis of new onset peripheral arterial disease and time to first diagnosis of 12 different vascular events.
  
  
  RESULTS
  A 20 mm Hg higher than usual systolic blood pressure was associated with a 63% higher risk of peripheral arterial disease (hazard ratio 1.63, 95% confidence interval 1.59 to 1.66). The strength of the association declined with increasing age and body mass index (P<0.001 for interaction) but was not modified by sex or smoking status. Peripheral arterial disease was associated with an increased risk of 11 different vascular events, including ischaemic heart disease (1.68, 1.58 to 1.79), heart failure (1.63, 1.52 to 1.75), aortic aneurysm (2.10, 1.79 to 2.45), and chronic kidney disease (1.31, 1.25 to 1.38), but not haemorrhagic stroke. The most common initial vascular event among those with peripheral arterial disease was chronic kidney disease (24.4% of initial events), followed by ischaemic heart disease (18.5% of initial events), heart failure (14.7%), and atrial fibrillation (13.2%). Overall estimates from this cohort were consistent with those derived from traditional studies when we pooled the findings in two meta-analyses.
  
  
  CONCLUSIONS
  Raised blood pressure is a strong risk factor for peripheral arterial disease in a range of patient subgroups. Furthermore, clinicians should be aware that those with established peripheral arterial disease are at an increased risk of a range of other vascular events, including chronic kidney disease, ischaemic heart disease, heart failure, atrial fibrillation, and stroke.
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Connor A
authors.initials: CA
authors.lastname: Emdin
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Anderson
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Callender
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Conrad
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Salimi-Khorshidi
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK.
authors.forename: Hamid
authors.initials: H
authors.lastname: Mohseni
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: The George Institute for Global Health, Oxford Martin School, University of Oxford, Oxford OX1 3DB, UK Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK kazem.rahimi@cardiov.ox.ac.uk.
authors.forename: Kazem
authors.initials: K
authors.lastname: Rahimi
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control