Hubungan Usia dan Lama Hipertensi dengan Kompleksitas Anatomi Pembuluh Darah Berdasarkan Klasifikasi GLASS pada Penyakit Arteri Perifer Ekstremitas Bawah
DOI:
https://doi.org/10.36452/jkdoktmeditek.v32i5.4369Keywords:
Age, duration of hypertension, GLASS, hypertension, peripheral artery diseaseAbstract
Introduction: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis common in elderly and hypertensive patients. Anatomical lesion complexity is assessed using the Global Limb Anatomic Staging System (GLASS), yet its association with age and hypertension duration remains understudied, particularly in Indonesia. This study aimed to assess the association of age and duration of hypertension with vascular anatomical complexity based on the GLASS classification in hypertensive PAD patients. Methods: This cross-sectional analytical observational study used medical record data from hypertensive PAD patients who underwent computed tomography angiography (CTA). Bivariate analysis used the One-Way ANOVA and Kruskal-Wallis tests, while multivariate analysis used ordinal logistic regression. Results: A total of 97 patients met the inclusion and exclusion criteria. The mean age was 64.65 ± 11.17 years, and the median duration of hypertension was 5 years (range: 1–35 years). GLASS stage distribution was dominated by stage III (43.3%), followed by stage II (41.2%) and stage I (14.4%). Age was not significantly associated with GLASS stage in bivariate analysis (p = 0.776), whereas duration of hypertension was (p = 0.044). In multivariate analysis, neither age nor duration of hypertension was significantly associated with GLASS stage (p > 0.05). Anatomical complexity in PAD cannot be predicted from age or hypertension duration alone, so revascularization still requires comprehensive GLASS evaluation. Conclusion: Age was not associated with lesion complexity as defined by GLASS, while hypertension duration showed a significant bivariate association not confirmed on multivariate analysis.
References
1. Conte MS. Lower Extremity Arterial Occlusive Disease: Epidemiology and Natural History. In: Rutherford’s Vascular Surgery and Endovascular Therapy, Tenth Edition: Volume 1-2. 2022.
2. Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. The Lancet. 2013.
DOI: http://dx.doi.org/10.1016/S0140-6736(13)61249-0
3. Kavurma MM, Bursill C, Stanley CP, Passam F, Cartland SP, Patel S, et al. Endothelial cell dysfunction: Implications for the pathogenesis of peripheral artery disease. Frontiers in Cardiovascular Medicine. 2022.
DOI: https://doi.org/10.3389/fcvm.2022.1054576
4. Fudim M, Hopley CW, Huang Z, Kavanagh S, Rockhold FW, Baumgartner I, et al. Association of Hypertension and Arterial Blood Pressure on Limb and Cardiovascular Outcomes in Symptomatic Peripheral Artery Disease: The EUCLID Trial. Circ Cardiovasc Qual Outcomes. 2020;13(9).
DOI: https://doi.org/10.1161/CIRCOUTCOMES.120.006512
5. Itoga NK, Tawfik DS, Lee CK, Maruyama S, Leeper NJ, Chang TI. Association of blood pressure measurements with peripheral artery disease events reanalysis of the ALLHAT data. Circulation. 2018;138(17).
DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.033348
6. Wu Z, Jiang Y, Zhu Q, Zhang H, Li Z, Wang J, et al. Combined Evaluation of Arterial Stiffness and Blood Pressure Promotes Risk Stratification of Peripheral Arterial Disease. JACC: Asia. 2023;3(2).
DOI: https://doi.org/10.1016/j.jacasi.2023.02.001
7. Kuntari T, Soleman SR. Determinants of Medication Non-Adherence among Productive-Aged Hypertensive Patients in Indonesia: A Secondary Data Analysis of Basic Health Research Database 2018. Iran J Public Health. 2025;54(4). DOI: https://doi.org/10.18502/ijph.v54i4.18415
8. Yunir E, Esa DF, Prahasary AN, Tahapary DL. Peripheral Arterial disease and Cardiovascular Mortality in Type-2 Diabetes Mellitus. Jurnal Penyakit Dalam Indonesia. 2019;6(2).
DOI: https://doi.org/10.7454/jpdi.v6i2.299
9. Herzog MJ, Müller P, Lechner K, Stiebler M, Arndt P, Kunz M, et al. Arterial stiffness and vascular aging: mechanisms, prevention, and therapy. Signal Transduction and Targeted Therapy. 2025.
DOI: https://doi.org/10.1038/s41392-025-02346-0
10. Zahner GJ, Gruendl MA, Spaulding KA, Schaller MS, Hills NK, Gasper WJ, et al. Association between arterial stiffness and peripheral artery disease as measured by radial artery tonometry. In: Journal of Vascular Surgery. 2017. DOI: http://dx.doi.org/10.1016/j.jvs.2017.06.068
11. Wijnand JGJ, Zarkowsky D, Wu B, van Haelst STW, Vonken EJPA, Sorrentino TA, et al. The global limb anatomic staging system (Glass) for clti: Improving inter-observer agreement. J Clin Med. 2021;10(16).
DOI: https://doi.org/10.3390/jcm10163454
12. Maximiano P, Oliveira N, Henrique A, Garcia R, Vieira I, Borges L, et al. The GLASS Scale as a Predictive Factor of Success After Endovascular Revascularisation of the Lower Limbs. EJVES Vasc Forum. 2022;54.
DOI: https://doi.org/10.1016/j.ejvsvf.2021.12.043
13. Houghton JSM, Saratzis AN, Sayers RD, Haunton VJ. New Horizons in Peripheral Artery Disease. Age Ageing. 2024;53(6). Available from: https://doi.org/10.1093/ageing/afae114
14. Soyoye DO, Abiodun OO, Ikem RT, Kolawole BA, Akintomide AO. Diabetes and peripheral artery disease: A review. World J Diabetes. 2021;12(6). DOI: https://doi.org/10.4239/wjd.v12.i6.827
15. Martinez A, Huang J, Harzand A. The Pink Tax: Sex and Gender Disparities in Peripheral Artery Disease. US Cardiology Review. 2024.
DOI: https://doi.org/10.15420/usc.2022.28
16. Schramm K, Rochon PJ. Gender Differences in Peripheral Vascular Disease. Semin Intervent Radiol. 2018;35(1).
DOI: https://doi.org/10.1055/s-0038-1636515
17. Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024.
DOI: https://doi.org/10.1161/CIR.0000000000001251
18. Luan TMB, Tuong NH, Dang TN, Khoa DD. Validation of the global limb anatomical staging system in Vietnamese patients treated for chronic limb-threatening ischemia. CVIR Endovasc. 2024;7(1).
DOI: https://doi.org/10.1186/s42155-024-00433-x
19. Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Cor Vasa. 2025;67(2). DOI: https://doi.org/10.33678/cor.2025.051
20. Liang P, Marcaccio CL, Darling JD, Kong D, Rao V, St John E, et al. Validation of the Global Limb Anatomic Staging System in first-time lower extremity revascularization. J Vasc Surg. 2021;73(5).
DOI: https://doi.org/10.1016/j.jvs.2020.08.151
21. Abraham AT, Mojaddedi S, Loseke IH, Bray C. Hypertension in Patients With Peripheral Artery Disease: An Updated Literature Review. Cureus. 2024. DOI: https://doi.org/10.7759/cureus.62246
22. Shahbad R, Pipinos M, Jadidi M, Desyatova A, Gamache J, MacTaggart J, et al. Structural and Mechanical Properties of Human Superficial Femoral and Popliteal Arteries. Annals of Biomedical Engineering. 2024.
DOI: https://doi.org/10.1007/s10439-023-03435-3
23. Zimmermann S, Klusmann D, Hampe W. Correcting the predictive validity of a selection test for the effect of indirect range restriction. BMC Med Educ. 2017;17(1). DOI: https://doi.org/10.1186/s12909-017-1070-5
24. Takahara M. Diabetes mellitus and peripheral artery disease. Diabetol Int. 2025 Jan 1;16(1):7–12. PubMed PMID: 39877447.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Hendrik Mark Jack Tampi, Alexander Jayadi Utama, Raden Suhartono
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
