Cardiovascular Outcomes in Hypertension-Treated Patients With Peripheral Artery Disease: The VALUE Trial

Hypertension. 2024 Jul;81(7):1628-1636. doi: 10.1161/HYPERTENSIONAHA.124.22832. Epub 2024 May 8.


Background: Systolic blood pressure (BP) is a key predictor of cardiovascular events, but patients with peripheral artery disease (PAD) are rarely included in hypertension trials. The VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation) investigated the long-term effects of valsartan- or amlodipine-based treatments on cardiovascular outcomes in patients with hypertension with a high cardiovascular risk. The aim of this subanalysis was to clarify the relationship between achieved BP on treatment and cardiovascular outcomes in patients with hypertension with PAD.

Methods: Patients were followed for 4 to 6 years, and BP was measured regularly. The primary end point was time to the first major adverse cardiovascular event, including myocardial infarction, stroke, cardiovascular death, and heart failure requiring hospitalization. Statistical analyses were performed using Cox regression, adjusting for various baseline covariates.

Results: Of the 13 803 participants, 1898 (13.8%) had PAD. During a median follow-up of 4.5 years, patients with PAD had a 23% increased risk of major adverse cardiovascular events compared with patients without PAD. Patients with an achieved systolic BP <130 mm Hg and 130 to 139 mm Hg, compared with those with systolic BP ≥140 mm Hg, were associated with a decreased risk of a major adverse cardiovascular event (hazard ratio, 0.65 [95% CI, 0.43-0.97]; P=0.037; 0.85 [95% CI, 0.74-0.97]; P=0.016, respectively). Additionally, systolic BP <130 mm Hg was associated with a decreased risk of cardiovascular death (hazard ratio, 0.33 [95% CI, 0.12-0.92]; P=0.034). The incidence of the primary outcome did not differ between antihypertensive treatment regimens (P=0.365).

Conclusions: Our results indicate that more intensive BP control is associated with a reduction in cardiovascular morbidity and mortality in patients with hypertensive PAD.

Keywords: antihypertensive agents; blood pressure; hypertension; mortality; peripheral artery disease.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Amlodipine* / therapeutic use
  • Antihypertensive Agents* / therapeutic use
  • Blood Pressure* / drug effects
  • Blood Pressure* / physiology
  • Cardiovascular Diseases / mortality
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension* / complications
  • Hypertension* / drug therapy
  • Hypertension* / physiopathology
  • Male
  • Middle Aged
  • Peripheral Arterial Disease* / complications
  • Peripheral Arterial Disease* / drug therapy
  • Peripheral Arterial Disease* / mortality
  • Peripheral Arterial Disease* / physiopathology
  • Treatment Outcome
  • Valsartan* / therapeutic use


  • Antihypertensive Agents
  • Valsartan
  • Amlodipine