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 .
Effect of high dose verapamil on restenosis after peripheral angioplasty.
OBJECTIVES We sought to determine whether treatment with high dose verapamil prevents restenosis in patients at high risk for reoccurrence after successful percutaneous transluminal coronary angioplasty ( PTCA ) . BACKGROUND Restenosis is the major limitation of PTCA . Calcium antagonists have demonstrated some potential as inhibitors of this process . METHODS A total of 98 patients with peripheral occlusive arterial disease ( POAD ) , stable angina pectoris , mild hypertension and at least one additional risk factor increasing the likelihood of restenosis after angioplasty were selected for this placebo-controlled , double-blind , r and omized trial .  Verapamil ( 240 mg twice daily ) or placebo was taken for 6 months . Efficacy variables assessed before and after angioplasty and at 6 weeks and 6 months after PTCA included thickness of the intima/media complex degree of stenosis , interventricular septal thickness , crurobrachial pressure ratios of dorsalis pedis and posterior tibial arteries , distance to claudication and total vessel diameter . RESULTS No significant intergroup differences emerged before or immediately after PTCA . Six weeks after angioplasty , a significant thickening of the intima/media complex in the treated vascular segment of 14.3 % occurred in the placebo group versus 0 % among verapamil patients ( p < 0.01 ) . At 6 months , the intima/media thickness was 35.7 % greater in the placebo group but had decreased by 14.3 % in the verapamil group ( p < 0.001 ) . At 6 months , a marked reduction in septal thickness was observed in the verapamil group versus that in the placebo group ( p < 0.001 ) . The rate of restenosis was also significantly lower in the verapamil group ( p < 0.001 ) . Few minor side effects were reported . CONCLUSIONS In patients with POAD at increased risk for restenosis , the administration of high dose verapamil prevented recurrent stenosis for 6 months after successful peripheral angioplasty and was well tolerated
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 .