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 .
Doxazosin and hydrochlorothiazide equally affect arterial wall thickness in hypertensive males with hypercholesterolaemia (the DAPHNE study). Doxazosin Atherosclerosis Progression Study in Hypertensives in the Netherlands.
BACKGROUND Observational studies suggest a synergistic effect of hypertension and hyperlipidaemia on the progression of atherosclerosis . The alpha-blocker doxazosin has favourable effects on plasma lipids , insulin resistance and blood pressure , while the diuretic hydrochlorothiazide ( HCTZ ) principally affects blood pressure and increases insulin resistance . METHODS A r and omised double-blind study over 36 months was performed to compare the effects of doxazosin and HCTZ on fasting lipids and on progression of peripheral atherosclerosis .  Eighty males ( 45 to 70 years ) with peripheral atherosclerotic disease and increased cholesterol levels ( 5.2 - 8.0 mmol/l ) were treated for essential hypertension with either doxazosin ( n = 41 ) or HCTZ ( n = 39 ) . Main outcome measures were arterial intima-media thickness ( IMT ) of the carotid and femoral arteries and fasting lipid parameters . RESULTS In the doxazosin-treated group , significant changes were observed in the concentration of triglycerides ( -13.7 % , p < 0.01 ) , HDLc ( + 25.7 % , p < 0.05 ) and IDLc ( -30.1 % , P < 0.05 ) . In the HCTZ-treated group no significant changes in plasma lipid levels were observed . On follow-up visits systolic blood pressure in the doxazosin-treated group was 6 mm higher than in the HCTZ group . Nevertheless , the groups treated with doxazosin or HCTZ showed no differential effect on IMT after three years of treatment ( p = 0.8 ) . A significant reduction of the IMT of combined carotid and femoral arterial walls was shown in both treatment groups ( p < 0.005 ) . CONCLUSIONS Hypertension treatment with doxazosin or HCTZ result ed in a comparable change in arterial IMT after three years , in spite of differences in effect on plasma lipids . The study emphasises the importance of blood pressure control in patients with peripheral vascular disease and hypercholesterolaemia
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 .