Peripheral arterial disease and high blood pressure

High blood pressure can lead to peripheral arterial disease (PAD), where narrowing of the blood vessels restricts the blood flow to the legs and feet, causing pain.

Importantly, PAD is often a sign that the blood vessels in other parts of your body may have also become narrowed, and if these blood vessels lead to the heart or brain, this could lead to a heart attack or stroke.

You can prevent PAD and even improve its symptoms by taking steps to lower your blood pressure.

What is peripheral artery disease (PAD)?

Peripheral arterial disease (PAD), also known as peripheral vascular disease and peripheral artery disease, is where one or more of the blood vessels leading to the legs and feet become narrow and hardened, reducing the blood flow. This can cause pain and make it harder to get around.

For many people PAD remains stable, but for some it can get gradually worse over time.

How does high blood pressure cause PAD?

High blood pressure can damage your arteries. Fatty deposits, known as plaques, can build up in the damaged areas, making the arteries narrower. This process is called atherosclerosis. Over time these plaques can become harder, making the arteries stiffer.

This narrowing and stiffening of the arteries means less blood can flow through them, restricting the blood supply to the part of the body they lead to. When the arteries leading to the legs and feet are affected, this is PAD.

What else causes PAD?
The lifestyle factors which lead to high blood pressure can also lead to PAD, in particular, smoking, being overweight or obese, lack of activity, an unhealthy diet, and drinking too much alcohol.

Other things which can mean you’re at higher risk are:

• age – about 20% of people aged over 60 have some degree of PAD
• high blood cholesterol – which can be laid down in the arteries
• diabetes – as diabetes can damage the blood vessels
• coronary artery disease
• being male – PAD tends to affect men more than women
• a family history of diseases affecting the blood vessels, including heart disease and stroke
• chronic kidney disease

The NHS has more information on what causes PAD and how you can prevent it.

What are the signs and symptoms of peripheral artery disease (PAD)?

Sometimes PAD has no symptoms, but the most common symptom is pain in the legs when you’re walking or exercising which goes away when you stop, after a short rest. The pain is caused by the lack of oxygen and energy in the muscles, as the blood flow is restricted.

The pain can feel like an aching, cramping or tiredness. It is often in the calves, but, depending on where the affected artery is, it could also be in your thighs or buttocks.

You may notice other signs and symptoms in your legs or feet:

• cold calves and feet compared to the rest of your body
• numbness or weakness
• sores or ulcers that don’t heal
• hair loss
• brittle toenails
• changes in skin colour or shiny skin
• weak or no pulse in the arteries in your feet
• pain which carries on even when you’re not moving about

Speak to your GP if you have any of the symptoms described here. The symptoms often develop slowly as the arteries become narrower. If they appear quickly it could be a sign of something that needs urgent treatment, such as a blood clot.

How is PAD diagnosed?

Your GP will ask you about your symptoms and examine your legs and feet to diagnose PAD.

They will also do a simple test where they measure the blood pressure in your arm and in your ankle. If the blood pressure in your ankle is much lower than the blood pressure in your arm (about 10% lower), it’s likely that the arteries in your legs have become narrower, and you may have PAD.

To find out which blood vessel or vessels are affected, you may also need a scan, such as an ultrasounds scan, but this is usually not needed.  

How is PAD treated?

It’s often possible to stop or slow down the progression of peripheral artery disease (PAD) and improve symptoms through a healthy lifestyle and medications. Surgery is also occasionally used, but only in severe cases. 

Lifestyle changes
The most important changes you can make are:

• stop smoking – this also makes a big difference to your risk of heart attacks
• exercise regularly – this improves the circulation in your legs
• lose weight if you’re overweight – to help prevent the build-up of fat in the arteries
• eat a healthy diet – this includes avoiding foods high in saturated fat, as this can build up in the arteries
• avoid too much alcohol – stay within the recommended limits

Walking is a great form of exercise for PAD, and you should walk every day. Walk until the pain becomes too much, rest for a few minutes, then start walking again. Keep going until you’ve walked for at least 30 minutes, or ideally an hour, several times a week. Although this can be tough, if you keep going, you should notice that you’re able to walk for longer without any pain.

Find out more about treating PAD and getting started with exercise from NHS Choices.  

Medicines
You may be given medicines to lower your blood pressure, usually ACE inhibitors or angiotensin receptor blockers. You might also have other medicines such as aspirin to help stop your blood from clotting, statins to lower your cholesterol levels.  If you have diabetes, you will need to keep your blood sugar under control.

These medications are to treat the underlying conditions which affect the blood vessels, so will also help to lower your risk of heart attacks and stroke.

How can I lower my risk of PAD?

By making healthy changes to lifestyle that lower your blood pressure and taking medications if you need to, you can lower your risk of developing PAD. You will also lower your risk of other diseases, such as heart disease and stroke.

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