Currently, there is no recommended drug of choice for the treatment of hypertension in patients with PAD because clinical trials of antihypertensive drug agents such as ACE inhibitors, calcium channel blockers (CCBs), -adrenergic blockers, and direct vasodilators have been largely unsuccess- ful in improving symptoms of claudication or walking dis- tance in patients with PAD.51 53 Although -blockers constrict resistance vessels, a meta-analysis concluded that this drug class does not worsen intermittent claudication in patients with intermittent claudication.54 Thus, -blockers can be used in PAD patients with compelling indications for their use such as CAD or HF. The recommendations of the ACC/AHA 2005 prac- tice guidelines on PAD55 include the following: (1) Antihypertensive therapy should be administered to hyperten- sive patients with lower-extremity PAD to achieve a goal of <140/90 mmHg (nondiabetics) or <130/80 mmHg (diabetics and individuals with chronic renal disease) to reduce the risk of MI, stroke, congestive HF, and cardiovascular death (Level of Evidence A); (2) -adrenergic blocking drugs are effective antihypertensive agents and are not contraindicated in patients with PAD (Level of EvidenceA); (3) the use ofACE inhibitors orARBs is reasonable for patients with symptomatic (Level of Evidence B) or asymptomatic (Level of Evidence C) leg PAD. 1.1.9. 