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Cochrane Database of Systematic Reviews

Treatment of hypertension in peripheral arterial disease

Información

DOI:
https://doi.org/10.1002/14651858.CD003075.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 04 diciembre 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Vascular

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Contraer

Autores

  • Deirdre A Lane

    University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

  • Gregory YH Lip

    Correspondencia a: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

    [email protected]

Contributions of authors

DAL updated the review.

GYHL identified and checked papers for relevance, and checked and edited the text of the review.

Sources of support

Internal sources

  • Sandwell & West Birmingham Hospitals NHS Trust, UK.

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.

    The PVD Group editorial base is supported by the Chief Scientist Office

Declarations of interest

DL has declared that she is in receipt of investigator‐initiated educational grants from Bayer Healthcare and Boehringer Ingelheim for studies not related to the topic of this review. She has also served on the speakers bureau for Boehringer Ingelheim, Bayer and BMS/Pfizer and received reimbursement of meeting expenses from Boehringer Ingelheim.
GYL has served as a consultant and board member and received meeting expenses from Bayer, Astellas, Merck, AstraZeneca, Sanofi, BMS/Pfizer, Biotronik, Portola and Boehringer Ingelheim; and served on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi‐Aventis. GYL has also reported receiving funds for development of educational presentations from Bayer, Merck, Sanofi, and Boehringer Ingelheim.

Acknowledgements

The authors would like to thank the HOPE investigators for providing unpublished data relating to the number of PAD patients randomised to ramipril or placebo. In addition, the authors would like to thank Dr Cathryn Broderick of the Cochrane Peripheral Vascular Disease Group for her support and assistance with the update of this review.

Version history

Published

Title

Stage

Authors

Version

2013 Dec 04

Treatment of hypertension in peripheral arterial disease

Review

Deirdre A Lane, Gregory YH Lip

https://doi.org/10.1002/14651858.CD003075.pub3

2009 Oct 07

Treatment of hypertension in peripheral arterial disease

Review

Deirdre A Lane, Gregory YH Lip

https://doi.org/10.1002/14651858.CD003075.pub2

2009 Jul 08

Treatment of hypertension in peripheral arterial disease

Review

Gregory YH Lip, Andrew J Makin

https://doi.org/10.1002/14651858.CD003075

Differences between protocol and review

None

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figuras y tablas -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Forest plot of comparison: 1 ACE inhibitors versus placebo, outcome: 1.1 Cardiovascular events.
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 ACE inhibitors versus placebo, outcome: 1.1 Cardiovascular events.

Forest plot of comparison: 1 ACE inhibitors versus placebo, outcome: 1.3 Maximum walking distance.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 ACE inhibitors versus placebo, outcome: 1.3 Maximum walking distance.

Forest plot of comparison: 2 Calcium antagonists versus placebo, outcome: 2.1 Degree of diameter stenosis.
Figuras y tablas -
Figure 5

Forest plot of comparison: 2 Calcium antagonists versus placebo, outcome: 2.1 Degree of diameter stenosis.

Forest plot of comparison: 2 Calcium antagonists versus placebo, outcome: 2.3 Arterial intima‐media thickness.
Figuras y tablas -
Figure 6

Forest plot of comparison: 2 Calcium antagonists versus placebo, outcome: 2.3 Arterial intima‐media thickness.

Comparison 1 ACE inhibitors versus placebo, Outcome 1 Cardiovascular events.
Figuras y tablas -
Analysis 1.1

Comparison 1 ACE inhibitors versus placebo, Outcome 1 Cardiovascular events.

Comparison 1 ACE inhibitors versus placebo, Outcome 2 Claudication distance.
Figuras y tablas -
Analysis 1.2

Comparison 1 ACE inhibitors versus placebo, Outcome 2 Claudication distance.

Comparison 1 ACE inhibitors versus placebo, Outcome 3 Maximum walking distance.
Figuras y tablas -
Analysis 1.3

Comparison 1 ACE inhibitors versus placebo, Outcome 3 Maximum walking distance.

Comparison 1 ACE inhibitors versus placebo, Outcome 4 Ankle brachial pressure index.
Figuras y tablas -
Analysis 1.4

Comparison 1 ACE inhibitors versus placebo, Outcome 4 Ankle brachial pressure index.

Comparison 2 Calcium antagonists versus placebo, Outcome 1 Degree of diameter stenosis.
Figuras y tablas -
Analysis 2.1

Comparison 2 Calcium antagonists versus placebo, Outcome 1 Degree of diameter stenosis.

Comparison 2 Calcium antagonists versus placebo, Outcome 2 Ankle brachial pressure index.
Figuras y tablas -
Analysis 2.2

Comparison 2 Calcium antagonists versus placebo, Outcome 2 Ankle brachial pressure index.

Comparison 2 Calcium antagonists versus placebo, Outcome 3 Arterial intima‐media thickness.
Figuras y tablas -
Analysis 2.3

Comparison 2 Calcium antagonists versus placebo, Outcome 3 Arterial intima‐media thickness.

Comparison 3 Thiazide diuretics versus alpha‐adrenoreceptor blocking drugs, Outcome 1 Arterial intima‐media thickness (IMT).
Figuras y tablas -
Analysis 3.1

Comparison 3 Thiazide diuretics versus alpha‐adrenoreceptor blocking drugs, Outcome 1 Arterial intima‐media thickness (IMT).

Study

Telmisartan (n = 18)

Placebo (n = 18)

Zankl 2010

Median (95% CI)

Median (95% CI)

Zankl 2010

191 (157 ‐ 226)

132 (103 ‐ 192)

Figuras y tablas -
Analysis 4.1

Comparison 4 Angiotensin‐II receptor antagonist versus placebo, Outcome 1 Maximum walking distance at 12 months (m).

Study

Telmisartan (n = 18)

Placebo (n = 18)

Zankl 2010

Median (95% CI)

Median (95% CI)

Zankl 2010

0.08 (0.07 ‐ 0.09)

0.09 (0.08 ‐ 1.00)

Figuras y tablas -
Analysis 4.2

Comparison 4 Angiotensin‐II receptor antagonist versus placebo, Outcome 2 Intima‐media thickness at 12 months (cm).

Study

Telmisartan (n = 18)

Placebo (n = 18)

Zankl 2010

Median (95% CI)

Median (95% CI)

Zankl 2010

0.60 (0.60 ‐ 0.77)

0.52 (0.48 ‐ 0.67)

Figuras y tablas -
Analysis 4.3

Comparison 4 Angiotensin‐II receptor antagonist versus placebo, Outcome 3 Ankle‐brachial pressure index.

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 1 Change in intermittent claudication distance.
Figuras y tablas -
Analysis 5.1

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 1 Change in intermittent claudication distance.

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 2 Absolute claudication distance.
Figuras y tablas -
Analysis 5.2

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 2 Absolute claudication distance.

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 3 Change in ankle brachial pressure index.
Figuras y tablas -
Analysis 5.3

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 3 Change in ankle brachial pressure index.

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 4 All‐cause mortality.
Figuras y tablas -
Analysis 5.4

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 4 All‐cause mortality.

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 5 Non‐fatal cardiovascular events.
Figuras y tablas -
Analysis 5.5

Comparison 5 Beta‐adrenoreceptor blockers versus thiazide diuretics, Outcome 5 Non‐fatal cardiovascular events.

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 1 All‐cause mortality.
Figuras y tablas -
Analysis 6.1

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 1 All‐cause mortality.

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 2 Ankle brachial pressure index.
Figuras y tablas -
Analysis 6.2

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 2 Ankle brachial pressure index.

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 3 Intermittent claudication distance.
Figuras y tablas -
Analysis 6.3

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 3 Intermittent claudication distance.

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 4 Absolute claudication distance.
Figuras y tablas -
Analysis 6.4

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 4 Absolute claudication distance.

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 5 Need for revascularisation.
Figuras y tablas -
Analysis 6.5

Comparison 6 Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers, Outcome 5 Need for revascularisation.

Comparison 7 Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy, Outcome 1 Composite endpoint of death, non‐fatal MI, or non‐fatal stroke.
Figuras y tablas -
Analysis 7.1

Comparison 7 Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy, Outcome 1 Composite endpoint of death, non‐fatal MI, or non‐fatal stroke.

Comparison 7 Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy, Outcome 2 Composite endpoint of death, non‐fatal MI or stroke, and revascularisation.
Figuras y tablas -
Analysis 7.2

Comparison 7 Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy, Outcome 2 Composite endpoint of death, non‐fatal MI or stroke, and revascularisation.

Comparison 1. ACE inhibitors versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Cardiovascular events Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Claudication distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Maximum walking distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Ankle brachial pressure index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. ACE inhibitors versus placebo
Comparison 2. Calcium antagonists versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Degree of diameter stenosis Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Ankle brachial pressure index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Arterial intima‐media thickness Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 2. Calcium antagonists versus placebo
Comparison 3. Thiazide diuretics versus alpha‐adrenoreceptor blocking drugs

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Arterial intima‐media thickness (IMT) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. Thiazide diuretics versus alpha‐adrenoreceptor blocking drugs
Comparison 4. Angiotensin‐II receptor antagonist versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maximum walking distance at 12 months (m) Show forest plot

Other data

No numeric data

2 Intima‐media thickness at 12 months (cm) Show forest plot

Other data

No numeric data

3 Ankle‐brachial pressure index Show forest plot

Other data

No numeric data

Figuras y tablas -
Comparison 4. Angiotensin‐II receptor antagonist versus placebo
Comparison 5. Beta‐adrenoreceptor blockers versus thiazide diuretics

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in intermittent claudication distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Absolute claudication distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Change in ankle brachial pressure index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 All‐cause mortality Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5 Non‐fatal cardiovascular events Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 5. Beta‐adrenoreceptor blockers versus thiazide diuretics
Comparison 6. Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 All‐cause mortality Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Ankle brachial pressure index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Intermittent claudication distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Absolute claudication distance Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Need for revascularisation Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 6. Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers
Comparison 7. Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Composite endpoint of death, non‐fatal MI, or non‐fatal stroke Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Composite endpoint of death, non‐fatal MI or stroke, and revascularisation Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 7. Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy