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 .
Effect of long-term beta-adrenergic-blockade on calf blood flow in hypertensive patients.
The effect of a four-week treatment with propranolol and metoprolol on blood pressure and regional haemodynamics of the lower extremity at rest , after exercise and during reactive hyperaemia was studied in 34 patients with essential hypertension , but without peripheral arterial disease , in a r and omized placebo-controlled trial . No significant difference in side-effects recorded during the trial was observed between these two drugs . Treatment with beta-adrenergic blocking drugs reduced systemic blood pressure . Calf blood flow during vasodilatation was also decreased . The most marked changes were observed during reactive hyperaemia ; mean calf blood flow was reduced from about 250 ml/min/litre of tissue to 200 ml/min/litre of tissue ( P less than 0.01 ) by propranolol and to 214 ml/min/litre of tissue ( P less than 0.01 ) by metoprolol . Both drugs caused a significant increase in peripheral resistance above the initial level during reactive hyperaemia ( P less than 0.05 ) . No significant difference in peripheral resistance was observed , however , when the active drugs were compared with the placebo . There was no difference between propranolol and metoprolol in any of the parameters . Thus , the flow reduction can mainly be attributed to the diminished perfusion pressure due to the decreased cardiac output caused by beta-blockade of the heart
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 .