Beta blockers for peripheral arterial disease

Abstract

BackgroundBeta (β) blockers are indicated for use in coronary artery disease (CAD). However, optimal therapy for people with CAD accompanied by intermittent claudication has been controversial because of the presumed peripheral haemodynamic consequences of beta blockers, leading to worsening symptoms of intermittent claudication. This is an update of a review first published in 2008. ObjectivesTo quantify the potential harmful e ects of beta blockers on maximum walking distance, claudication distance, calf blood flow, calf vascular resistance and skin temperature when used in patients with peripheral arterial disease (PAD). Search methodsFor this update, the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2013, Issue 2). Selection criteriaRandomised controlled trials (RCTs) evaluating the role of both selective (β1) and non-selective (β1 and β2) beta blockers compared with placebo. We excluded trials that compared di erent types of beta blockers. Data collection and analysisPrimary outcome measures were claudication distance in metres, time to claudication in minutes and maximum walking distance in metres and minutes (as assessed by treadmill).Secondary outcome measures included calf blood flow (mL/100 mL/min), calf vascular resistance and skin temperature (ºC). Main resultsWe included six RCTs that fulfilled the above criteria, with a total of 119 participants. The beta blockers studied were atenolol, propranolol, pindolol and metoprolol. All trials were of poor quality with the drugs administered over a short time (10 days to two months). None of the primary outcomes were reported by more than one study. Similarly, secondary outcome measures, with the exception of vascular resistance (as reported by three studies), were reported, each by only one study. Pooling of such results was deemed inappropriate. None of the trials showed a statistically significant worsening e ect of beta blockers on time to claudication, claudication distance and maximal walking distance as measured on a treadmill, nor on calf blood flow, calf vascular resistance and skin temperature, when compared with placebo. No reports described adverse events associated with the beta blockers studied.

A 'diamond' approach to personalized treatment of angina

“…In 2013, the British Medical Association declared that β-blockers were contra indicated in severe peripheral artery disease 88 . The same year, a systematic Cochrane Review provided no strong evidence for or against the use of β-blockers in peripheral artery disease 89 . Given the paucity of reliable and contemporary data, the consensus of our group is that β-blockers should be avoided or used with caution in patients with chronic stable angina and peripheral artery disease.…”

Beta-blocker Treatment Does Not Worsen Critical Limb Ischemia in Patients Receiving Endovascular Therapy

“…However, beta-blockers do not exacerbate claudication symptoms 1,2) , and the incidence of ischemic cardiac disease and subsequent cardiovascular events is high in many PAD patients 3,4) . Beta-blockers (BBs) suppress cardiovascular events [5][6][7][8][9] and the potential use of these drugs in patients with PAD is discussed in the Trans-Atlantic Inter-Society consensus (TASC ) guidelines 4) .…”

The Management of Peripheral Arterial Disease (PAD) in Primary Care

“…A recent Cochrane review of 6 RCCTs of beta-blocker vs. placebo in PAD showed no statistically significant worsening effect of beta-blockers on maximum walking distance, claudication distance, calf blood flow or skin temperature (Paravastu et al, 2008). An earlier meta-analysis of 11 RCCTs again showed no evidence of adverse effects on walking capacity or symptoms of intermittent claudication in patients with mild to moderate PAD (Feringa et al, 2006).…”