No coin nor oath required. For personal study only.
Aims: β-Blockers are widely used in hypertension and ischaemic heart disease. Patients afflicted with these conditions often also suffer from peripheral vascular disease. There is the popular belief that β-blockers should not be used in patients with peripheral vascular disease (PVD) due to the theoretical risk of unopposed β stimulation as stated in the British National Formulary, but what is the evidence for this? Methods: All randomised, controlled, clinical trials (RCTs) were electronically searched on MEDLINE, EMBASE and Cochrane databases from 1996 to December 2003. The primary outcome measures were claudication distance and maximal walking distance. Secondary outcome measures were calf blood flow, calf vascular resistance and skin temperature. Data were extracted using the Revman's proforma and a meta-analysis was carried out using the statistical guidelines (Cochrane PVD group).
The cumulative meta-analysis demonstrated an improved claudication distance with the use of β-blockers (four RCTs). Similarly, the graphs for calf blood flow (three RCTs) and skin temperature (two RCTs) showed a clear distinction from the midline favouring treatment. None of the graphs demonstrated a decline in the outcome measures. The statistical results of the graphs are discussed. Conclusions: This meta-analysis dispels the myth surrounding β-blockers and PVD. The above results reveal no contraindications to the use of β-blockers in PVD patients. In severe disease they should be used cautiously because of the risk of reducing trans-stenotic blood pressure by a central effect, whereas in milder forms, it may improve circulation by a reverse steal phenomenon.
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