However , lack of data specifically examining outcomes in PAD patients should not detract from the overwhelming evidence on the benefit of treating hypertension and lowering blood pressure
BACKGROUND Peripheral arterial disease ( PAD ) causes considerable morbidity and mortality .
Hypertension is a risk factor for PAD .
Treatment for hypertension must be compatible with the symptoms of PAD .
Controversy regarding the effects of beta-adrenoreceptor blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-adrenoreceptor blockers .
Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD .
This is the second up date of a Cochrane review first published in 2003 .
OBJECTIVES To determine the effects of anti-hypertensive drugs in patients with both raised blood pressure and symptomatic PAD in terms of the rate of cardiovascular events and death , symptoms of claudication and critical leg ischaemia , and progression of atherosclerotic PAD as measured by ankle brachial index ( ABI ) changes and the need for revascularisation ( reconstructive surgery or angioplasty ) or amputation .
[Hemodynamic effects of chronic treatment by cilazapril in normotensive patients with obliterative arterial diseases of the lower limbs].
OBJECTIVE To determine whether long-term treatment with cilazapril ( CIL ) may improve pulse pressure ( PP ) , arterial compliance and ankle-arm systolic index ( AAI ) in patients with lower-extremity arterial disease ( LEAD ) . Indeed , in both systolic hypertension and LEAD , the increase in pulse pressure has been attributed to a reduced compliance . DESIGN AND METHODS Thirteen patients ( age : 65 + /- 5 yrs ; AAI : 0.78 + /- 0.15 ; m + /- SD ) were included in a double-blind r and omized parallel study to compare the effects of a 6 month treatment with CIL ( 10 mg per day ; n = 6 ) to those of placebo ( PL ; n = 7 ) Blood pressure , AAI and arterial compliance were determined at baseline ( MO ) and after 3 ( M3 ) and 6 months ( M6 ) . Common carotid ( CC ) and common femoral ( CF ) artery compliances were noninvasively determined from pulsatile changes in arterial diameter ( Wall Track System , Hoeks et al. , 1990 ) and pressure ( PP ) . RESULTS Both groups were comparable at MO . Compared to PL , CIL significantly reduced PP ( -22 + /- 4 vs -2 + /- 9 mmHg ) and MAP ( -16 + /- 11 vs -4 + /- 7 mmHg ) and improved CC ( + 54 + /- 34 vs + 5 + /- 21 mm2.mmHg-1.10(-3 ) ) at M6 . Weaker effects were observed at M3 . No significant changes in AAI and CF compliance were observed . CONCLUSIONS A direct effect of CIL on the large artery wall was suggested by 1 ) a greater reduction in PP than in MAP and 2 ) a disproportionately greater improvement in CC compliance compared with the reduction in distending pressure ( MAP ) . These results indicate that long-term treatment with CIL may improve large artery function in patients with LEAD
However , lack of data specifically examining outcomes in PAD patients should not detract from the overwhelming evidence on the benefit of treating hypertension and lowering blood pressure
BACKGROUND Peripheral arterial disease ( PAD ) causes considerable morbidity and mortality .
Hypertension is a risk factor for PAD .
Treatment for hypertension must be compatible with the symptoms of PAD .
Controversy regarding the effects of beta-adrenoreceptor blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-adrenoreceptor blockers .
Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD .
This is the second up date of a Cochrane review first published in 2003 .
OBJECTIVES To determine the effects of anti-hypertensive drugs in patients with both raised blood pressure and symptomatic PAD in terms of the rate of cardiovascular events and death , symptoms of claudication and critical leg ischaemia , and progression of atherosclerotic PAD as measured by ankle brachial index ( ABI ) changes and the need for revascularisation ( reconstructive surgery or angioplasty ) or amputation .