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, ramipril, or both in high-risk Chinese patients: analysis of ONTARGET China data.
BACKGROUND The results from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial ( ONTARGET ) indicated that the angiotensin-receptor blocker telmisartan was not inferior to the angiotensin-converting-enzyme inhibitor ramipril in reducing the composite endpoint of cardiovascular death , myocardial infa rct ion , stroke or hospitalization for congestive heart failure in high-risk patients , and telmisartan was associated with slightly superior tolerability . The combination of the two drugs was associated with more adverse events without an increase in benefit . This study aim ed to analyze the data from ONTARGET obtained from a subgroup of patients enrolled in China and to evaluate the demographic and baseline characteristics , the compliance , efficacy , and safety of the different treatment strategies in r and omized patients in China . METHODS A total of 1159 high-risk patients were r and omized into three treatment groups : with 390 assigned to receive 80 mg of telmisartan , 385 assigned to receive 10 mg of ramipril and 384 assigned to receive both study medications . The median follow-up period was 4.3 years . RESULTS The mean age of Chinese patients was 65.6 years , 73.6 % of patients were male . The proportion of patients with stroke/transient ischemic attacks at baseline in China was two times more than the entire study population ( 47.7 % vs. 20.9 % ) . In Chinese patients the proportion of permanent discontinuation of study medication due to cough was 0.5 % in the telmisartan group , which was much less than that in the combination or the ramipril group . There were no significant differences in the incidence of primary outcome among three treatment groups of Chinese patients . More strokes occurred in Chinese patients than in the entire study population ( 8.5 % vs. 4.5 % ) . Greater systolic blood pressure reduction ( -9.8 mmHg ) , and more renal function failure were noted in the combination treatment group than in the ramipril or telmisartan group ( 2.6 % vs. 1.6 % and 1.0 % ) . CONCLUSIONS There was no evidence that the results of ONTARGET differed between Chinese patients and the entire study population with respect to the incidence of primary outcome , particularly safety . Compliance with study medications was good . The evidence from ONTARGET indicated that the treatment strategies in ONTARGET were applicable to patients in China
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 .