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 .
Verapamil-sustained release-based treatment strategy is equivalent to atenolol-based treatment strategy at reducing cardiovascular events in patients with prior myocardial infarction: an INternational VErapamil SR-Trandolapril (INVEST) substudy.
BACKGROUND In patients with prior myocardial infa rct ion ( MI ) , beta-blockers reduce mortality by 23 % to 40 % . However , despite this favorable effect , adverse effects limit compliance to this medication . The purpose of the study was to compare a beta-blocker-based strategy with a heart rate-lowering calcium antagonists-based strategy in patients with prior MI . METHODS We evaluated 7,218 patients with prior MI enrolled in the INternational VErapamil SR-Tr and olapril ( INVEST ) sub study r and omized to verapamil-sustained release (SR)- or atenolol-based strategies . Primary outcome was time to first occurrence of death ( all-cause ) , nonfatal MI , or nonfatal stroke . Secondary outcomes included death , total MI ( fatal and nonfatal ) , and total stroke ( fatal and nonfatal ) considered separately . RESULTS During the 2.8 + /- 1.0 years of follow-up , patients assigned to the verapamil-SR-based and atenolol-based strategies had comparable blood pressure control , and the incidence of the primary outcome was equivalent . There was no difference between the 2 strategies for the outcomes of either death or total MI . However , more patients reported excellent/good well-being ( 82.3 % vs 78.0 % , P = .02 ) at 24 months with a trend toward less incidence of angina pectoris ( 12.0 % vs 14.3 % , adjusted P = .07 ) , nonfatal stroke ( 1.4 % vs 2.0 % ; P = .06 ) , and total stroke ( 2.0 % vs 2.5 % , P = .18 ) in the verapamil-SR-based strategy group . CONCLUSIONS In hypertensive patients with prior MI , a verapamil-SR-based strategy was equivalent to a beta-blocker-based strategy for blood pressure control and prevention of cardiovascular events , with greater subjective feeling of well-being and a trend toward lower incidence of angina pectoris and stroke in the verapamil-SR-based group
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 .