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 .
Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: a randomized controlled trial.
IMPORTANCE Approximately one-third of patients with peripheral artery disease experience intermittent claudication , with consequent loss of quality of life . OBJECTIVE To determine the efficacy of ramipril for improving walking ability , patient-perceived walking performance , and quality of life in patients with claudication . DESIGN , SETTING , AND PATIENTS R and omized , double-blind , placebo-controlled trial conducted among 212 patients with peripheral artery disease ( mean age , 65.5 [ SD , 6.2 ] years ) , initiated in May 2008 and completed in August 2011 and conducted at 3 hospitals in Australia . INTERVENTION Patients were r and omized to receive 10 mg/d of ramipril ( n = 106 ) or matching placebo ( n = 106 ) for 24 weeks . MAIN OUTCOME MEASURES Maximum and pain-free walking times were recorded during a st and ard treadmill test . The Walking Impairment Question naire ( WIQ ) and Short-Form 36 Health Survey ( SF-36 ) were used to assess walking ability and quality of life , respectively . RESULTS At 6 months , relative to placebo , ramipril was associated with a 75-second ( 95 % CI , 60 - 89 seconds ) increase in mean pain-free walking time ( P < .001 ) and a 255-second ( 95 % CI , 215 - 295 seconds ) increase in maximum walking time ( P < .001 ) . Relative to placebo , ramipril improved the WIQ median distance score by 13.8 ( Hodges-Lehmann 95 % CI , 12.2 - 15.5 ) , speed score by 13.3 ( 95 % CI , 11.9 - 15.2 ) , and stair climbing score by 25.2 ( 95 % CI , 25.1 - 29.4 ) ( P < .001 for all ) . The overall SF-36 median Physical Component Summary score improved by 8.2 ( Hodges-Lehmann 95 % CI , 3.6 - 11.4 ; P = .02 ) in the ramipril group relative to placebo . Ramipril did not affect the overall SF-36 median Mental Component Summary score . CONCLUSIONS AND RELEVANCE Among patients with intermittent claudication , 24-week treatment with ramipril result ed in significant increases in pain-free and maximum treadmill walking times compared with placebo . This was associated with a significant increase in the physical functioning component of the SF-36 score . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00681226
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 .