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 .
Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease
Background Peripheral artery disease ( PAD ) is associated with high cardiovascular mortality and a poor quality of life . The AT1-receptor blocker telmisartan has been shown to have pleiotropic effects and it may also improve endothelial function . The aim of this study was to analyze the effects of telmisartan on absolute walking distance ( WD ) and endothelial function in patients with PAD . Methods In a single centre , single-blinded , prospect i ve study , 36 patients with PAD at stage Fontaine II or higher and mild to moderate arterial hypertension were treated with telmisartan 40/80 mg once daily or placebo for 12 months . Primary endpoint was the improvement of the absolute treadmill WD . Flow-mediated vasodilation ( FMD ) , carotid intima-media thickness ( IMT ) , ankle-brachial index ( ABI ) and disease-related quality of life ( DRQL ) were examined as well . Results After 12 months , maximum WD increased by 26 % in the telmisartan group ( P < 0.001 ) . However , in the placebo group it was comparable to baseline . FMD rose by 40 % in the telmisartan group while it deteriorated in the placebo group ( P < 0.001 ) . IMT and ABI were comparable in both groups at baseline and did not change considerably after 12 months . In non-diabetic patients ( 72.2 % ) , the ABI did not change in the placebo group , whereas it increased by 11 % in the telmisartan group ( P < 0.001 ) . While the DRQL remained stable in the telmisartan group , placebo treatment was associated with a marked deterioration ( P < 0.01 ) . Conclusion Telmisartan improves WD and endothelial function , the ABI in non-diabetic patients and it may prevent further loss of quality of life in patients with advanced PAD
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 .