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 .
Reduced arterial stiffness may contribute to angiotensin-converting enzyme inhibitor induced improvements in walking time in peripheral arterial disease patients
Objective Claudication is a debilitating consequence of peripheral arterial disease . Evidence is accumulating to suggest that large artery stiffness may influence peripheral perfusion and walking time through effects on peripheral hemodynamics as well as microvascular structure and function . We have previously shown that the angiotensin-converting enzyme inhibitor ramipril increased systemic arterial compliance by 64 % , and increased maximum walking time by over 200 % in patients with peripheral arterial disease . In the current analysis in the same patient cohort , we hypothesized that this relationship may , in part , be causal . Methods Forty patients with peripheral arterial disease [ 66 ± 4 years ( mean ± SD ) ; n = 20 per group ] were r and omized to ramipril , 10 mg once daily , or placebo for 24 weeks in a double-blind study  . Maximum walking time was recorded during a st and ard treadmill test  . Indices of arterial stiffness were assessed globally by systemic arterial compliance and augmentation index and regionally via central pulse wave velocity . Results Ramipril  increased maximum walking time by 243 % and improved arterial stiffness parameters by between 17 and 64 % ( all P < 0.001 compared with placebo ) . There were moderately strong correlations between the pre/post intervention change in maximum walking time and the change in indices of arterial stiffness ( systemic arterial compliance , r = 0.65 , P < 0.001 ; central pulse wave velocity , r = −0.57 , P < 0.001 ; augmentation index , r = −0.79 , P < 0.001 ; time to pressure augmentation , r = 0.52 , P = 0.001 ) . Conclusion The present data support the hypothesis that the beneficial effects of ramipril on maximum walking time observed in our peripheral arterial disease population are , at least partly , a consequence of reduced arterial stiffness
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 .