Key result
Anti-hypertensive medications did not significantly affect maximum walking distance (SMD -0.155), pain-free walking distance, or ankle brachial pressure index in patients with peripheral artery disease.
Why the study?
It has been suggested that anti-hypertensive medications may worsen leg ischemia in peripheral artery disease patients, but the effect remains unclear.
Do anti-hypertensive medications improve measures of leg ischemia in patients with intermittent claudication due to peripheral artery disease?
Meta-Analysis (n=307)
Do anti-hypertensive medications improve measures of leg ischemia in patients with intermittent claudication due to peripheral artery disease?
Standardized Mean Difference: -0.155 (95% CI -0.617–0.306)
Anti-hypertensive medications do not worsen and may improve leg ischemia in patients with peripheral artery disease, as greater blood pressure reductions correlated with increased walking distance.
Antihypertensives do not worsen leg ischemia in PAD; challenges longstanding concerns and supports BP control in this population.
BACKGROUND: It has been suggested that anti-hypertensive medications may worsen leg ischemia in peripheral artery disease (PAD) patients. We undertook a meta-analysis to assess the effect of anti-hypertensive medications on measures of leg ischemia including maximum walking distance (MWD), pain free walking distance (PFWD) and ankle brachial pressure index (ABPI). A meta-regression was performed to evaluate whether the effect of the anti-hypertensive medications on mean arterial pressure (MAP) was associated with changes in ABPI, MWD or PFWD. METHOD: A systematic literature search was performed to identify placebo controlled randomized control trials (RCT) testing anti-hypertensive medications, which reported baseline and follow-up measurements of: MAP and MWD, PFWD or ABPI in patients with intermittent claudication (IC) due to PAD. RESULT: A meta-analysis was performed on 5 RCTs comprising a total of 180 and 127 patients receiving anti-hypertensive medications and placebo respectively. This analysis suggested that anti-hypertensive medication did not significantly affect MWD, PFWD or ABPI. In contrast, the meta-regression analysis showed that the reduction in MAP due to the anti-hypertensive drugs was positively correlated with increased MWD during follow-up (β = 8.371, p = 0.035). Heterogeneity across studies, as assessed by I2, was high. The follow-up period within the included trials was generally short with 3 out of 5 studies having a follow-up period of ≤ 6 weeks. CONCLUSION: This study suggests that anti-hypertensive treatment does not worsen but may improve leg ischemia in PAD patients. Larger multicenter trials with longer anti-hypertensive treatment periods are required to clarify the effect of anti-hypertensives on leg ischemia in PAD patients.
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Manapurathe et al. (2017) conducted a meta-analysis in Intermittent claudication due to peripheral artery disease (n=307). Anti-hypertensive medications vs. Placebo was evaluated on Maximum walking distance (MWD) (SMD -0.155, 95% CI -0.617-0.306). Anti-hypertensive medications did not significantly affect maximum walking distance (SMD -0.155), pain-free walking distance, or ankle brachial pressure index in patients with peripheral artery disease.
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