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 .
&bgr;-Blockers in Patients With Intermittent Claudication and Arterial Hypertension: Results From the Nebivolol or Metoprolol in Arterial Occlusive Disease Trial
The use of & bgr;-receptor blockers in peripheral arterial disease is controversial for their impact on vasomotor tone . The & bgr;-blocker nebivolol possesses vasodilating , endothelium-dependent , NO-releasing properties that might be beneficial in peripheral arterial disease . The aim of the study was to evaluate the effects and tolerability of nebivolol in comparison with metoprolol in these patients . A total of 128 patients with intermittent claudication and essential hypertension were included and double-blind r and omized to receive 5 mg of nebivolol ( N=65 ) or 95 mg of metoprolol ( N=63 ) once daily . End points were changes in ankle-brachial index , initial and absolute claudication distance , endothelial function assessed by flow-mediated dilatation of the brachial artery , blood pressure , and quality of life using the claudication scale question naire . End point analysis was possible in 109 patients ( 85.2 % ) . After the 48-week treatment period , ankle-brachial index and absolute claudication distance improved significantly in both patient groups ( P<0.05 for both ) , with no difference across treatments . A significant increase of initial claudication distance was found in the nebivolol group . Adjusted mean change of initial claudication distance was 33.9 % after nebivolol ( P=0.003 ) and 16.6 % after metoprolol ( P=0.12 ) treatment . Quality of life was not influenced by either treatment , and there was no relevant change in flow-mediated dilatation in patients treated with nebivolol or metoprolol ( P=0.16 ) . Both drugs were equally effective in lowering blood pressure . In conclusion , & bgr;-blocker therapy was well tolerated in patients with intermittent claudication and arterial hypertension during a treatment period of ≈1 year . In the direct comparison , there was no significant difference between nebivolol and metoprolol
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 .