Chronic effects of metoprolol and methyldopa on calf blood flow in intermittent claudication.

Lepäntalo, Mauri

doi:10.1111/j.1365-2125.1984.tb05027.x

Cited by 19 publications

(14 citation statements)

References 14 publications

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“…Some studies showed worsening of intermittent claudication in response to therapy with ␤-receptor blockers, but the number of patients included into these trials was quite small. [13][14][15][16][17] Based on these findings, a recent meta-analysis concluded that, because of lack of large randomized trials, ␤-blockers should be used with caution in patients with intermittent claudication. 22 Nevertheless, despite possible adverse effects on clinical symptoms, ␤-blockers are widely used in PAD patients because of their prognostic impact, clinical experience suggests that ␤-blockers are often well tolerated in daily practice, and current guidelines recommend their use in PAD patients if indicated in particular in patients with CAD and arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…6 -12 On the one hand, ␤-blockers are contraindicated in the setting of severe PAD, and previous studies reported a worsening in parameters related to quality of life, functional capacity, and clinical symptoms also in stable PAD patients treated with nonvasodilating ␤-blockers. [13][14][15][16][17] On the other hand, some studies did not show adverse effects of ␤-blockers in PAD patients. 18 -21 In addition, several meta-analyses suggest that ␤-blockers do not adversely affect walking distance in patients with intermittent claudication.…”

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confidence: 99%

“…25,26 The ␤-blocker nebivolol possesses unique vasodilating, endothelium-dependent, NO-releasing properties, which might be particularly beneficial in patients with PAD, because an impaired reactivity of the vascular endothelium has been associated with adverse outcome in patients with this condition. 26 -29 The issue of the impact of ␤-blockers in PAD has been addressed by few trials, mostly with a small sample size and often only short treatment periods, [13][14][15][16][17][18][19][20][21] and studies comparing ␤-blockers with and without vasodilating effects using a double-blind randomized design are lacking.…”

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β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension

et al. 2011

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Abstract-The use of ␤-receptor blockers in peripheral arterial disease is controversial for their impact on vasomotor tone.The ␤-blocker nebivolol possesses vasodilating, endothelium-dependent, NO-releasing properties that might be beneficial in peripheral arterial disease. The aim of the study was to evaluate the effects and tolerability of nebivolol in comparison with metoprolol in these patients. A total of 128 patients with intermittent claudication and essential hypertension were included and double-blind randomized to receive 5 mg of nebivolol (Nϭ65) or 95 mg of metoprolol (Nϭ63) once daily. End points were changes in ankle-brachial index, initial and absolute claudication distance, endothelial function assessed by flow-mediated dilatation of the brachial artery, blood pressure, and quality of life using the claudication scale questionnaire. End point analysis was possible in 109 patients (85.2%). After the 48-week treatment period, ankle-brachial index and absolute claudication distance improved significantly in both patient groups (PϽ0.05 for both), with no difference across treatments. A significant increase of initial claudication distance was found in the nebivolol group. Adjusted mean change of initial claudication distance was 33.9% after nebivolol (Pϭ0.003) and 16.6% after metoprolol (Pϭ0.12) treatment. Quality of life was not influenced by either treatment, and there was no relevant change in flow-mediated dilatation in patients treated with nebivolol or metoprolol (Pϭ0.16). Both drugs were equally effective in lowering blood pressure. In conclusion, ␤-blocker therapy was well tolerated in patients with intermittent claudication and arterial hypertension during a treatment period of Ϸ1 year. In the direct comparison, there was no significant difference between nebivolol and metoprolol. (Hypertension. 2011;58:148-154.)

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β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension

et al. 2011

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“…Moreover, the studies included in this review were performed in Finland, 12,13) Denmark, 14,15) Belgium, 16,17) Israel, 18) and the USA. 16,19) Investigation of racial diŠerences and a-receptor sensitivity in patients with IC is necessary.…”

Section: Discussionmentioning

confidence: 99%

β-Adrenergic Blocking Agents and Intermittent Claudication: Systematic Review

2004

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To clarify contradictions in past reports and the package inserts for b-adrenergic blocking agents ( b-blockers) for patients with intermittent claudication (IC), we investigated the eŠects of b-blockers in patients with IC using the systematic review technique. Data sources were randomized, controlled trials that investigated the eŠects of b-blockers compared with the placebo or untreated group (controls) in patients with IC. Primary endpoints were walking distance and walking time, and secondary endpoints were ankle-brachial index (ABI) and calf blood ‰ow. Nine trials were included in the analysis. Meta-analysis showed that there was a signiˆcant worsening in maximal walking distance and initial claudication distance in patients receiving b-blockers, with standardized mean diŠerences of -0.31 and -0.39 (95 ％ conˆdence interval -0.58 to -0.04 and -0.73 to -0.06, P＝0.03 and 0.02, respectively) compared with controls. There were no signiˆcant diŠerences in maximal walking time (0.07, -0.24 to 0.37), time to onset of claudication (0.12, -0.23 to 0.47), ABI at rest (0.24, -0.30 to 0.78), calf blood ‰ow at rest (0.00, -0.26 to 0.25), and calf blood ‰ow after exercise (-0.23, -0.69 to 0.22). However, only one trial evaluated ABI, and the number of cases is increasing, suggesting that b-blockers do not worsen ABI. There was no evidence that b-blockers prescribed for patients with IC have unsuitable``precautions'' in the package inserts. However, reluctance to administer b-blockers to patients because they have IC is not appropriate.

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“…It is therefore appropriate to assess the effects different antihypertensive agents may have on limb blood flow and vascular resistance during treatment. Further, such measurements may be useful in predicting the effects of antihypertensive agents on the lower limb circulation in patients with hypertension complicated by peripheral vascular disease (McSorley & Warren, 1978;Lepantalo, 1984). Changes in limb blood flow may be a direct consequence of alteration in vascular resistance, a change in cardiac output (C.O.)…”

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Haemodynamic effects of atenolol, labetalol, pindolol and captopril: a comparison in hypertensive patients with special reference to changes in limb blood flow, heart rate and left ventricular function.

Roberts

Tsao

Grimmer

et al. 1987

Brit J Clinical Pharma

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1 To compare the haemodynamic effects of secondary characteristics of beta‐adrenoceptor blockers with an angiotensin converting enzyme inhibitor forty patients with previously untreated mild to moderate hypertension were prescribed either atenolol 50‐100 mg day‐1, labetalol 200‐800 mg day‐1, pindolol 10‐30 mg day‐1 or captopril 25‐100 mg day‐1 and observed for 6 months. 2 Over this period: (a) All four drugs produced similar reductions in blood pressure at rest (P less than or equal to 0.01) and after exercise (P less than or equal to 0.01). (b) All four drugs significantly decreased resting forearm (P less than or equal to 0.01) and calf blood flow (P less than or equal to 0.01). They all also caused a significant reduction in the increased calf blood flow following exercise (P less than or equal to 0.01). (c) No drug produced a change in resting forearm vascular resistance, while resting calf vascular resistance was decreased by captopril and pindolol, unaltered by labetalol and increased by atenolol. Post‐exercise calf vascular resistance was increased by atenolol, labetalol and pindolol but unaltered by captopril. (d) Although all four drugs produced a fall in resting heart rate this was significantly greater for atenolol and labetalol (P less than or equal to 0.01). All four treatments however significantly reduced the increase in heart rate following exercise (P less than or equal to 0.01). (e) No drug produced any significant change in resting and post‐exercise stroke volume/ejection fraction. 3 It is concluded that despite differing modes of action all four drugs reduce limb blood flow. This primarily appears to be a consequence of reduced perfusion pressure associated with limited autoregulation of skeletal muscle circulation. The reduction in arterial vascular resistance produced by captopril and pindolol is inconsistent and does not appear of major benefit in preserving limb blood flow. The reduction in perfusion with the agents studied may in part be related to a fall in cardiac output associated with decreased heart rate. This suggests that captopril may exert antisympathetic activity when used as an antihypertensive agent.

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Chronic effects of metoprolol and methyldopa on calf blood flow in intermittent claudication.

Cited by 19 publications

References 14 publications

β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension

β-Blockers in Patients With Intermittent Claudication and Arterial Hypertension

β-Adrenergic Blocking Agents and Intermittent Claudication: Systematic Review

Haemodynamic effects of atenolol, labetalol, pindolol and captopril: a comparison in hypertensive patients with special reference to changes in limb blood flow, heart rate and left ventricular function.

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