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 .
ACE-inhibition with perindopril in essential hypertensive patients with concomitant diseases. The Perindopril Therapeutic Safety Collaborative Research Group.
PURPOSE Many hypertensive patients have other , usually long-term diseases . Antihypertensive therapy may interfere with these diseases and their therapies . In the present study , the possible interactions of the ACE-inhibitor perindopril with several of the most common long-term diseases was evaluated . PATIENTS AND METHODS In a multicenter , double-blind , r and omized , placebo-controlled trial , the effect of perindopril was evaluated in 490 patients with mild essential hypertension and any one of the following concomitant diseases : hyperlipidemia , type II diabetes mellitus , ischemic heart disease , cardiac arrhythmia , peripheral arterial occlusive disease , nephropathy with proteinuria , chronic obstructive pulmonary disease , or degenerative joint disease treated with nonsteroidal anti-inflammatory drugs ( NSAIDs ) . After a 3-week single-blind placebo run-in , the patients received either perindopril ( 4 mg/d ) or matching placebo for 6 weeks . RESULTS Blood pressure was effectively reduced by perindopril irrespective of the associated disease . The rate of spontaneously reported side effects was low . Treatment with perindopril was free from adverse interactions with the concomitant diseases and therapies . Moreover , favorable actions could be observed in patients with ischemic heart disease ( reduction of maximal ST-segment depression during peak exercise and decrease in the number of angina attacks ) , in patients with proteinuria ( decrease in albuminuria in patients with normal serum creatinine levels ) , and in patients with NSAID-treatment ( increase in prostagl and in E2 concentration in gastric mucosa suggesting gastric cytoprotection ) . CONCLUSION This trial shows that ACE-inhibition with perindopril represents a simple , safe , and effective short-term therapeutic option for the large proportion of patients with mild essential hypertension and concomitant diseases and therapies
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 .