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 .
Beta blockade and intermittent claudication.
The aim of the present study was to evaluate whether beta blockade presents a risk of intermittent claudication and how it affects the walking capacity and lower limb haemodynamics in patients with intermittent claudication . The study was divided into six parts : A case-control study with 55 pairs , cases with hypertension and intermittent claudication and controls with hypertension only , matched for age , sex , place of residence , and time of examination , all without coronary heart disease , which is a known confounding factor . An open controlled study on the effect of withdrawal of beta blockade on walking capacity of 28 patients with intermittent claudication . A placebo-controlled double-blind crossover study on the effect of antihypertensive treatment on the walking capacity of 14 patients with intermittent claudication . Three placebo-controlled double-blind crossover studies on the effect of propranolol , metoprolol , pindolol , labetalol , and /or methyldopa on calf blood flow in 34 hypertensive subjects without peripheral arterial disease and in altogether 21 patients with intermittent claudication .  Walking capacity was measured on a treadmill . Calf blood flow was measured with strain gauge plethysmography by the venous occlusion technique . The case-control comparison showed that beta blockers were used as often by patients with intermittent claudication as by controls . Walking capacity increased during the first month of the open controlled study irrespective of whether the beta blockade was withdrawn or continued . There was no difference in this respect between the various types of beta blockers . Antihypertensive treatment with metoprolol or methyldopa did not affect walking capacity . Resting calf blood flow was unaffected by propranolol or metoprolol , regardless of the presence or absence of peripheral arterial disease , as well as by pindolol , labetalol , or methyldopa in patients with intermittent claudication . During reactive hyperaemia , propranolol and metoprolol reduced flow in patients without peripheral arterial disease . Propranolol also reduced hyperaemic blood flow in the limb with less or no symptoms in patients with intermittent claudication . None of the active drugs decreased the hyperaemic flow consistently in the limb with the stronger symptoms . In a comparison of haemodynamic effects between the drugs , calf blood flow at rest was higher after pindolol than after propranolol and hyperaemic flow of the better limb was higher after pindolol than after propranolol and labetalol . ( ABSTRACT TRUNCATED AT 400 WORDS
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 .