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Recommendations for
Antihypertensive Agents |
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COR |
LOE |
Recommendations |
|
I |
A |
Antihypertensive therapy should
be administered to patients with hypertension and PAD to reduce
the risk of MI, stroke, heart failure, and cardiovascular
death.158–162
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See Online Data Supplements 17 and
18. |
Treatment of elevated blood pressure is
indicated to lower the risk of cardiovascular events.162 Target blood
pressure and selection of antihypertensive therapy should be
consistent with current published guidelines for hypertension
management. Concerns have been raised that antihypertensive therapy
may reduce limb perfusion. However, multiple studies have
demonstrated that blood pressure treatment, including the use of
beta blockers, does not worsen claudication symptoms or impair
functional status in patients with PAD.163–165 There is no evidence that
one class of antihypertensive medication or strategy is superior for
blood pressure lowering in PAD.158,166,167 An updated multisocietal guideline on the
management of high blood pressure is anticipated in 2017. |
|
IIa |
A |
The use of angiotensin-converting
enzyme inhibitors or angiotensin-receptor blockers can be
effective to reduce the risk of cardiovascular ischemic events
in patients with PAD.161,168,169
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|
See Online Data Supplement
17. |
The effect of ramipril versus placebo
on cardiovascular events was studied in high-risk patients free of
heart failure in the HOPE (Heart Outcomes Prevention Evaluation)
trial.168,169 Patients were
normotensive on average at the time of enrollment. In a subgroup of
4051 patients with PAD, ramipril reduced the risk of MI, stroke, or
vascular death by 25%, similar to the efficacy in the entire
study population.168,169 The efficacy was similar in patients with PAD
with symptomatic disease and asymptomatic low ABI.168 ONTARGET
(Ongoing Telmisartan Alone and in Combination With Ramipril Global
Endpoint Trial) compared telmisartan, ramipril, and combination
therapy in patients with cardiovascular disease, including PAD,
and/or diabetes mellitus.161 All 3 treatments had similar
cardiovascular event rates with higher rates of adverse events
(including hypotension, syncope, and renal failure) in the
combination-therapy group. The efficacy of telmisartan was similar
in the subgroup of 3468 patients with PAD, which supports the use of
angiotensin-receptor blockers as an alternative to
angiotensin-converting enzyme inhibitors.161 The effect of
angiotensin-receptor blockers in asymptomatic PAD has not been
studied. |
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