Management of hypertension in peripheral arterial disease: does the choice of drugs matter?

Cardiovascular disease and death are major life-threatening problems in patients with atheromatous peripheral arterial disease (PAD). This review focuses on management of hypertension in the context of cardiovascular risk in patients with PAD. PAD is underdiagnosed and hypertension in PAD is often poorly managed. Current evidence supports a low threshold for blood pressure treatment in PAD and intensive blood pressure control to reduce the high risk of cardiovascular disease and death in patients with PAD. Optimal treatment targets should be <140/85 mmHg, with the lower target of <130/80 mmHg in the presence of diabetes mellitus or chronic renal disease. Class-specific selection of anti-hypertensive treatments in PAD should be based on caution in relation to co-existing renovascular disease and indications and contraindications based on other significant co-morbidity. There is a pressing need for primary end-point studies targeted specifically at patients with PAD. In particular, prospective studies in PAD are needed to obtain evidence for benefits from specific blood pressure classes of treatment as well as the optimal blood pressure treatment target level. These studies should consider impact in PAD of different demographic, risk factor, and co-morbidity profiles.