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 .
Relation between risk factors and cardiovascular complications in patients with peripheral vascular disease. Results from the A.D.E.P. study.
The relationship between risk factors and the onset of cardiovascular events was analyzed in patients suffering from peripheral obstructive arterial disease . One thous and and eleven patients were recruited in 120 Italian centers and participated in a clinical trial on picotamide ( A.D.E.P. study ) , whose results have been previously reported . Patients were followed-up for 18 months and cardiovascular events were recorded . Hypertension ( 35 % ) , smoking ( 34 % ) , and diabetes ( 19 % ) were the most common risk factors at baseline . During the follow-up period , 246 patients ( 11.7 % ) had a cardiovascular event , mainly affecting cerebral , cardiac or peripheral circulation . Thirty-five of these events ( 14.2 % ) were fatal . A logistic regression analysis showed in general that hypertension ( odds ratio 1.48 ) , an ankle arm pressure ratio lower than 0.8 ( odds ratio 1.42 ) , smoking ( odds ratio 1.43 ) , previous vascular surgery ( odds ratio 1.35 ) , high white blood cell ( WBC ) count ( odds ratio 1.15 for a difference of 2.0 x 10(9 ) WBC/1 ) and plasma fibrinogen ( odds ratio 1.16 for a difference of 1.05 g/l ) were significantly associated with a higher incidence of cardiovascular events . In particular , deaths of any origin were more frequent in patients with an ankle/arm pressure ratio below 0.8 . High plasma fibrinogen increased the risk of cerebrovascular events , hypertension or coronary heart events and , to a less evident extent , peripheral vascular complications and cerebrovascular events . A history of vascular surgery increased the risk of peripheral vascular complications . Both smoking and a high WBC count showed to be borderline significant risk factors for coronary heart events and the former also for peripheral vascular complications . In male patients ( 84 % ) , ankle/arm pressure ratio lower than 0.8 , high fibrinogen and hypertension were the most important factors for cardiovascular events . This study helps to identify some categories at higher risk of cardiovascular events among patients with peripheral obstructive arterial disease ; this finding is useful to plan future trials to decrease the frequency of such complications
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 .