Treatment of Hypertension

Hypertension is a major risk factor for PAD, but data are not available to clarify whether treatment will alter the progression of the disease or the risk of claudication. Beta-adrenergic-antagonist drugs have been thought to have unfavorable effects on symptoms in patients with PAD. This concern arose from several early case reports of worsening claudication and decreases in blood flow in the legs in patients taking these drugs. A meta-

analysis and a critical review of different studies, however, concluded that beta-adrenergic antagonists are safe in patients with PAD, except in the most severely affected patients, in whom the drugs should be administered with caution.7,8

The use of angiotensin-converting enzyme inhibitors in patients with peripheral arterial disease may confer protection against cardiovascular events beyond that expected from lowering of blood pressure. In the Heart Outcomes Prevention Evaluation Study,9 4051 of the 9297 patients (44%) had evidence of peripheral arterial disease (ankle-brachial index values of <0.90). In the entire study population, the primary endpoint of death from vascular causes, nonfatal myocardial infarction, or stroke occurred in 17.7% of the placebo group, as compared with 14.1% of the ramipril group. The efficacy of ramipril did not differ significantly between patients with PAD and those without it. This study suggests that angiotensin-converting enzyme inhibitors reduce the risk of ischemic events in PAD patients.

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