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 .
PLACEBO-CONTROLLED COMPARISON OF CAPTOPRIL, ATENOLOL, LABETALOL, AND PINDOLOL IN HYPERTENSION COMPLICATED BY INTERMITTENT CLAUDICATION
In a six month placebo-controlled cross-over trial twenty patients with hypertension and peripheral arterial disease were r and omised to captopril 25 mg twice daily , atenolol 100 mg once daily , labetalol 200 mg twice daily , or pindolol 10 mg twice daily for one month . Although all treatments were equally effective at lowering blood pressure , pain-free and maximum walking distances on a treadmill were decreased by  atenolol , labetalol , and  pindolol  , but not by captopril .  Post-exercise calf blood flow availability was impaired by  atenolol , labetalol , and  pindolol  , but not by captopril . Despite ancillary characteristics of cardioselectivity , intrinsic sympathomimetic activity , or combination with alpha-blockade , beta-blockers seem to impair the lower limb circulation in such patients , whereas captopril seems to preserve it , possibly by maintaining the collateral blood supply
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 .