Clin Exp Hypertens. 2026 Dec 31;48(1):2756089. doi: 10.1080/10641963.2026.2756089. Epub 2026 Oct 30.
ABSTRACT
BACKGROUND: Peripheral artery disease (PAD) is common but often underrecognized in people with hypertension because symptoms are frequently absent or atypical and access to physiologic testing is uneven. This narrative review examines how hypertension care can support risk-stratified PAD recognition while keeping targeted case-finding distinct from universal screening.
METHODS: We conducted a structured narrative review of PubMed/MEDLINE from inception through 31 July 2026, supplemented by citation searching and review of major US and European guidelines and relevant US policy and coverage sources. Evidence was interpreted according to the question it could answer: association/prognosis, diagnostic accuracy, treatment effect, implementation, or policy status.
RESULTS: Hypertension and PAD share age-related, metabolic, renal, and tobacco-related determinants, while pressure-related vascular injury provides biological plausibility for their association. Resting ankle-brachial index (ABI) is the initial physiologic test for appropriately selected people; toe-brachial index with waveforms is preferred for noncompressible ankle arteries, exercise ABI for persistent exertional symptoms despite normal or borderline resting values, and duplex ultrasound when anatomic definition will change management. Guideline-supported risk-based testing differs from universal screening of unselected asymptomatic adults, for which outcome benefit remains unproven. Detection is clinically meaningful only when linked to appropriate prevention, symptom management, foot protection, and referral.
CONCLUSION: This narrative review supports a risk-stratified, treatment-linked approach to PAD recognition in hypertension care, but the proposed case-finding pathway itself has not been proven to improve clinical outcomes. Pragmatic trials of the complete care pathway are needed.
PMID:42961865 | DOI:10.1080/10641963.2026.2756089