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 .
Left ventricular mass and volume with telmisartan, ramipril, or combination in patients with previous atherosclerotic events or with diabetes mellitus (from the ONgoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial [ONTARGET]).
The ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial ( ONTARGET ) showed that the angiotensin receptor blocker telmisartan 80 mg was not inferior to the angiotensin-converting enzyme inhibitor ramipril 10 mg , and the combination no more effective than ramipril alone , in decreasing morbidity and mortality in patients with cardiovascular disease or high-risk diabetes . Although therapy targeting angiotensin II is known to decrease left ventricular ( LV ) mass and volume , the relative influence of angiotensin-converting enzyme inhibitor inhibitors and angiotensin receptor blocker , and their combination , on the heart remains unclear in this population . Magnetic resonance imaging was performed in 287 patients enrolled in ONTARGET , across 8 centers in 6 countries , at r and omization and after 2-year treatment ( 90 , 100 , and 97 patients in the ramipril , telmisartan , and combination therapy groups , respectively ) . Baseline patient characteristics showed higher frequencies of coronary artery disease , Asian ethnicity , and use of statins and beta blockers than the main ONTARGET trial . LV mass decreased in all groups ( p < 0.0001 for each ) , but there were no significant differences in change in LV mass or volume among groups , except that LV mass index decreased more on combination versus telmisartan ( p = 0.04 ) . Key determinants of LV mass decrease were a history of hypertension ( p = 0.03 ) , baseline mass ( p < 0.0001 ) , and decrease in systolic blood pressure ( p < 0.0001 ) . The best magnetic resonance imaging predictor of composite events was end-systolic volume ( p < 0.0001 ) . In conclusion , telmisartan and ramipril had similar effects on LV mass and volume , and combination therapy was not more effective , in high-risk patients with cardiovascular disease . These results are consistent with the major outcome findings of the main ONTARGET study
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 .