Treatment of hypertension in peripheral arterial disease

Deirdre A Lane; Gregory YH Lip

doi:10.1002/14651858.CD003075.pub3

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Figure 1

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

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Figure 5

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

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Figure 6

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 3.1

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

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Study	Telmisartan (n = 18)	Placebo (n = 18)
Zankl 2010	Median (95% CI)	Median (95% CI)
Zankl 2010	191 (157 ‐ 226)	132 (103 ‐ 192)

Analysis 4.1

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

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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)

Analysis 4.2

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

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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)

Analysis 4.3

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

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Analysis 5.1

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

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Analysis 5.2

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

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Analysis 5.3

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

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Analysis 5.4

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

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Analysis 5.5

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

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Analysis 6.1

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

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Analysis 6.2

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

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Analysis 6.3

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

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Analysis 6.4

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

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Analysis 6.5

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

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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.

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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.

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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

Comparison 1. ACE inhibitors versus placebo

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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

Comparison 2. Calcium antagonists versus placebo

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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

Comparison 3. Thiazide diuretics versus alpha‐adrenoreceptor blocking drugs

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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

Comparison 4. Angiotensin‐II receptor antagonist versus placebo

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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

Comparison 5. Beta‐adrenoreceptor blockers versus thiazide diuretics

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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

Comparison 6. Beta‐adrenoreceptor blockers versus beta‐adrenoreceptor blockers

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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

Comparison 7. Calcium antagonist‐based strategy versus beta‐adrenoreceptor blocker‐based strategy

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