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 .
Erectile Dysfunction Predicts Cardiovascular Events in High-Risk Patients Receiving Telmisartan, Ramipril, or Both: The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONT
Background — Although erectile dysfunction ( ED ) is associated with cardiovascular risk factors and atherosclerosis , it is not known whether the presence of ED is predictive of future events in individuals with cardiovascular disease . We evaluated whether ED is predictive of mortality and cardiovascular outcomes , and because inhibition of the renin-angiotensin system in high-risk patients reduces cardiovascular events , we also tested the effects on ED of r and omized treatments with telmisartan , ramipril , and the combination of the 2 drugs ( ONTARGET ) , as well as with telmisartan or placebo in patients who were intolerant of angiotensin-converting enzyme inhibitors ( TRANSCEND ) . Methods and Results — In a prespecified sub study , 1549 patients underwent double-blind r and omization , with 400 participants assigned to receive ramipril , 395 telmisartan , and 381 the combination thereof ( ONTARGET ) , as well as 171 participants assigned to receive telmisartan and 202 placebo ( TRANSCEND ) . ED was evaluated at baseline , at 2-year follow-up , and at the penultimate visit before closeout . ED was predictive of all-cause death ( hazard ratio [ HR ] 1.84 , 95 % confidence interval [ CI ] 1.21 to 2.81 , P=0.005 ) and the composite primary outcome ( HR 1.42 , 95 % CI 1.04 to 1.94 , P=0.029 ) , which consisted of cardiovascular death ( HR 1.93 , 95 % CI 1.13 to 3.29 , P=0.016 ) , myocardial infa rct ion ( HR 2.02 , 95 % CI 1.13 to 3.58 , P=0.017 ) , hospitalization for heart failure ( HR 1.2 , 95 % CI 0.64 to 2.26 , P=0.563 ) , and stroke ( HR 1.1 , 95 % CI 0.64 to 1.9 , P=0.742 ) . The study medications did not influence the course or development of ED . Conclusions — ED is a potent predictor of all-cause death and the composite of cardiovascular death , myocardial infa rct ion , stroke , and heart failure in men with cardiovascular disease . Trial treatment did not significantly improve or worsen ED . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT 00153101
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 .