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 .
Vascular wall thickness in hypertension: the Perindopril Regression of Vascular Thickening European Community Trial (PROTECT).
A high prevalence of increased intima/media thickness of the arterial wall has been documented in hypertension . These alterations in vascular wall structure may be potent determinants for the promotion of the development of atherosclerosis . Direct histologic data from animal models of hypertension , and indirect data from hypertensive patients , have demonstrated a marked regression of increased intima/media thickness by angiotensinconverting enzyme ( ACE ) inhibition . Long-term effects of ACE inhibition on structural wall changes in humans have not been examined . Therefore , a multicenter , r and omized , double-blind European trial was design ed to compare the effects of the ACE inhibitor perindopril and the diuretic hydrochlorothiazide in slowing or reversing progression of increased intima/media thickness of carotid and femoral arteries in hypertensive patients . A total of 800 patients at 17 clinical centers in 7 European countries , aged 35–65 years , with hypertension and ultrasonographically proven intima/media thickness ≥0.8 mm of the common carotid artery will be r and omly assigned to receive in a doubleblind fashion either perindopril or hydrochlorothiazide and will be followed for 24 months . High resolution duplex sonography will be used to quantify intima/media thickness at baseline and twice a year during follow-up . A change of 0.1 mm of intima/media thickness from baseline is considered to be detectable , and the st and ard deviations of the changes from baseline are expected not to be higher than 0.2 mm . The primary endpoint of the study is the comparison of changes in intima/media thickness of the common carotid artery . Secondary endpoints include comparison of the effectiveness of the two treatments on left ventricular mass , posterior wall thickness , intraventricular septal thickness , left ventricular end-diastolic diameter , and comparison of the 2 treatments on ultrasonographically determined thickness of the intima/media complex of the common femoral artery . Further analyses will assess the relation between intima/ media thickness changes and the changes of blood pressure , heart rate , low and high density lipoprotein cholesterol , triglycerides , and glucose . The study is design ed to assess the impact of antihypertensive therapy on early pathological vascular wall changes and to clarify whether this is due to a drug-specific action or only dependent on the blood pressure lowering effect
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 .