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 .
Assessment of Captopril and Nicardipine Effects on Chronic Occlusive Arterial Disease of the Lower Extremity Using Doppler Ultrasound
The effects of two potent vasodilating drugs , captopril ( C ) ( 25 mg tid ) , nicar dipine ( N ) ( 20 mg tid ) , and placebo ( P ) were evaluated and compared , in 10 men ( mean age of sixty-five years ) with intermittent claudication from moderate to severe multilevel chronic occlusive arterial disease ( COAD ) of the lower extrem ity , by use of the Doppler ultrasonic method , at rest and after Carter 's exercise test . All the examined subjects were normotensive , without diabetes or cardio pathy ; all have been smokers . The eight-week total protocol consisted of an initial two-week placebo run-in period followed by two active drug phases and a two-week placebo phase , ac cording to a double-blind , r and omized , crossover design . At the end of each two-week period , ankle-arm index ( AAI ) and , following exercise , onset of lower extremity discomfort time ( ODT ) , duration of exercise ( ET ) , decrease of ankle systolic pressure after test ( APD ) , and recovery time ( RT ) were determined . Moreover , at rest , just after exercise , and after recovery , simultaneous common femoral artery velocity waves were recorded and analyzed by a quantitative approach to detect the peripheral vasomotor adjustments . None of the patients required the withdrawal of the active treatments . Com pared with P , C significantly reduced APD and RT , and N reduced RT and AAI ; furthermore N caused a significant decrease in ODT , whereas C showed a trend , although not statistically significant , to increase ODT . Neither active therapy modified ET . These results suggest that C and N have different short-term effects on pe ripheral circulation in COAD . During exercise , C induces hemodynamic i m provement in the ischemic lower extremity probably by inhibition of the sympathetic system and consequent reduction in collateral vessel vasoconstric tion
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 .