Lane Deirdre A, Lip Gregory Yh
Haemostasis Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, UK, B18 7QH.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD003075. doi: 10.1002/14651858.CD003075.pub2.
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-blockade for hypertension in patients with PAD has led many physicians to stop prescribing beta-blockers. Little is known about the effects of other classes of anti-hypertensive drugs in the presence of PAD. This is an update of a Cochrane review first published in 2003.
To determine the effects of anti-hypertensive drugs on cardiovascular events and death, symptoms of claudication, critical leg ischaemia, progression of PAD and revascularisation or amputation in people with hypertension and PAD SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched May 2009) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2). The authors studied abstracts of cardiology meetings.
Randomised controlled trials of at least one anti-hypertensive treatment against placebo, or two anti-hypertensive medications against each other, with interventions lasting at least one month. Trials had to include patients with symptomatic PAD.
Data were extracted by one author (DAL) and checked by the other (GYHL). Eligible studies were excluded when results presentation prevented adequate extraction of data and enquiries to authors did not yield raw data.
Four studies were included. Two compared ACE inhibitors against placebo. In the HOPE study there was a significant reduction in the number of cardiovascular events in 168 patients receiving ramipril (OR 0.72, 95% confidence interval 0.58 to 0.91). In the second trial using perindopril in a small numbers of patients, there was a marginal increase in claudication distance but no change in ankle brachial pressure index (ABPI) and a reduction in maximum walking distance.The third trial in patients undergoing angioplasty suggested that the calcium antagonist verapamil reduced restenosis, although this was not reflected in the maintenance of a high ABPI. Another small study demonstrated no significant difference in arterial intima-media thickness with men receiving the thiazide diuretic hydrochlorathiazide compared to those receiving the alpha-adrenoreceptor blocker doxazosin.
AUTHORS' CONCLUSIONS: Evidence on various anti-hypertensive drugs in people with PAD is poor so that it is unknown whether significant benefits or risks accrue from their use. Lack of data specifically examining outcomes in PAD patients should not detract from the compelling evidence of the benefit of treating hypertension and lowering blood pressure.
外周动脉疾病（PAD）会导致相当高的发病率和死亡率。高血压是PAD的一个危险因素。高血压的治疗必须与PAD的症状相兼容。关于β受体阻滞剂对PAD患者高血压的影响存在争议，这导致许多医生停止开具β受体阻滞剂。对于其他类别的抗高血压药物在PAD患者中的作用知之甚少。这是2003年首次发表的Cochrane综述的更新版。
确定抗高血压药物对高血压合并PAD患者心血管事件和死亡、间歇性跛行症状、严重下肢缺血、PAD进展以及血管重建或截肢的影响。
Cochrane外周血管疾病小组检索了其专业注册库（最后检索时间为2009年5月）和Cochrane对照试验中央注册库（《Cochrane图书馆》2009年第2期）。作者研究了心脏病学会议的摘要。
至少一种抗高血压治疗与安慰剂对照，或两种抗高血压药物相互对照的随机对照试验，干预持续时间至少为一个月。试验必须纳入有症状的PAD患者。
数据由一位作者（DAL）提取，另一位作者（GYHL）进行核对。当结果呈现妨碍了充分的数据提取且向作者查询未得到原始数据时，符合条件的研究被排除。
纳入了四项研究。两项研究比较了血管紧张素转换酶（ACE）抑制剂与安慰剂。在心脏结局预防评估（HOPE）研究中，168名接受雷米普利治疗的患者心血管事件数量显著减少（比值比0.72，95%置信区间0.58至0.91）。在第二项使用培哚普利的小规模试验中，间歇性跛行距离略有增加，但踝臂压力指数（ABPI）无变化，最大行走距离减少。第三项针对接受血管成形术患者的试验表明，钙拮抗剂维拉帕米可减少再狭窄，尽管这并未体现在维持较高的ABPI上。另一项小型研究表明，与接受α肾上腺素能受体阻滞剂多沙唑嗪的男性相比，接受噻嗪类利尿剂氢氯噻嗪的男性动脉内膜中层厚度无显著差异。
关于各类抗高血压药物在PAD患者中的证据不足，因此尚不清楚使用这些药物是否会带来显著益处或风险。缺乏专门针对PAD患者结局的数据不应减损治疗高血压和降低血压有益的有力证据。
