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 .
Invasive hemodynamic evaluation of sublingual captopril and nifedipine in patients with arterial hypertension after abdominal aortic surgery.
OBJECTIVES To examine the central hemodynamic and blood gas responses to sublingual captopril and nifedipine administration in patients with arterial hypertension after abdominal aortic surgery . DESIGN Prospect i ve , r and omized , parallel-group clinical study . SETTING Twenty-nine-bed medical-surgical intensive care unit in a university hospital . PATIENTS Twenty patients with arterial hypertension ( mean arterial pressure of > or = 115 mm Hg ) the day after abdominal aortic surgery . Patients with bilateral renal artery stenoses , identified with the preoperative angiogram , were excluded . INTERVENTIONS Pressures were measured using intravascular catheters and cardiac output was determined by thermodilution for 2 hrs after captopril 25 mg ( n = 10 ) or nifedipine 10 mg ( n = 10 ) was administered by the sublingual route . MEASUREMENTS AND MAIN RESULTS Captopril administration and nifedipine administration decreased mean arterial pressure ( from 121 + /- 1 to 94 + /- 4 mm Hg and from 121 + /- 2 to 94 + /- 2 [ sem ] mm Hg , respectively ) , pulmonary arterial pressure , pulmonary artery occlusion pressure , and right atrial pressure ( p < .001 for all variables ) . Changes in heart rate and in cardiac output were not significant . PaO2 decreased after nifedipine , from 101 + /- 8 to 81 + /- 3 torr [ 13.5 + /- 1.1 to 10.8 + /- 0.4 kPa ] ( p < .01 ) , but not after captopril ( 104 + /- 9 to 100 + /- 7 torr [ 13.9 + /- 1.2 to 13.3 + /- 0.9 kPa ] ) . Excessive or symptomatic decreases in blood pressure were not observed , nor was deterioration in renal function observed . CONCLUSIONS Sublingual captopril and nifedipine were equally effective for the treatment of arterial hypertension after abdominal aortic surgery . Nifedipine , but not captopril , caused a deterioration in pulmonary gas exchange
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 .