Hypertension and peripheral arterial disease

Patients with hypertension and PAD should be treated with a comprehensive program of risk factor modification. If no contraindications exist, patients should receive a statin and an antiplatelet agent to lower overall cardiovascular risk. Blood pressure should be lowered to goal levels as recommended in the most recent consensus report. In most situations the antihypertensive agent of choice as a first line drug should be an ACE inhibitor. This is especially true in the diabetic population because not only do the ACE inhibitors lower cardiovascular morbidity and mortality at least in some part independent of their blood pressure lowering effects, but they are renal protective as well. If a second agent needs to be added, one can follow the recommendations of JNC 7 and use agents in any of the other classes. In patients requiring more than two drugs, a diuretic should be used as one of the blood pressure lowering agents. While beta-blockers do not worsen walking distance in most patients with PAD, their use should be reserved for patients who have other indications for beta-blocker administration such as those with angina, heart failure, postmyocardial infarction, aortic dissection or arrythmias.