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 .
beta blockade and intermittent claudication: placebo controlled trial of atenolol and nifedipine and their combination.
OBJECTIVE --To determine the effects of the beta 1 selective adrenoceptor blocker atenolol , the dihydropyridine calcium antagonist nifedipine , and the combination of atenolol plus nifedipine on objective and subjective measures of walking performance and foot temperature in patients with intermittent claudication . DESIGN --R and omised controlled double blind four way crossover trial . SETTING --Royal Hallamshire Hospital , Sheffield . SUBJECTS--49 patients ( 40 men ) aged 39 - 70 with chronic stable intermittent claudication . INTERVENTIONS --Atenolol 50 mg twice daily ; slow release nifedipine 20 mg twice daily ; atenolol 50 mg plus slow release nifedipine 20 mg twice daily ; placebo . Each treatment was given for four weeks with no washout interval between treatments . MAIN OUTCOME MEASURES --Claudication and walking distances on treadmill ; skin temperature of feet as measured by thermistor and probe ; blood pressure before and after exercise ; subjective assessment s of walking difficulty and foot coldness with visual analogue scales . RESULTS --Atenolol did not significantly alter claudication distance ( mean change -6 % ; 95 % confidence interval 1 % to -13 % ) , walking distance ( -2 % ; 4 % to -8 % ) , or foot temperature .  Nifedipine did not alter claudication distance ( -4 % ; 3 % to -11 % ) , walking distance ( -4 % ; 3 % to -10 % ) , or foot temperature .  Atenolol plus nifedipine did not alter claudication distance but significantly reduced walking distance ( -9 % ; -3 % to -15 % ( p less than 0.003 ) ) and skin temperature of the more affected foot ( -1.1 degrees C ; 0 to -2.2 degrees C ( p = 0.05 ) ) . These effects on walking distance and foot temperature seemed unrelated to blood pressure changes . CONCLUSIONS --There was no evidence of adverse or beneficial effects of atenolol or nifedipine , when given singly , on peripheral vascular disease . The combined treatment , however , affected walking ability and foot temperature adversely . This may have been due to beta blockade plus reduced vascular resistance , which might also explain the reported adverse effects of pindolol and labetalol on claudication
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 .