Effect of beta‐adrenoceptor antagonists on prevalence of peripheral vascular symptoms in hypertensive patients.

Steiner, JA; Cooper, Robert C.; McPherson, Klim; Aj, Riley

doi:10.1111/j.1365-2125.1982.tb02045.x

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Indeed, β 2 ‐adrenoceptors are involved in the vasodilator tone of blood vessels in skeletal muscle. However, studies did not show any difference in the frequency of the feeling of cold hands according to β 1 ‐selectivity of β‐adrenoceptor blockers . Based on a large basis of available evidence, our study further shows that drugs with higher affinity for β 1 ‐ than for β 2 ‐adrenoceptors, such as atenolol, also induce significantly more peripheral vasoconstriction than placebo.…”

Section: Discussionsupporting

confidence: 46%

Peripheral vasoconstriction induced by β‐adrenoceptor blockers: a systematic review and a network meta‐analysis

Khouri

Jouve

Blaise

et al. 2016

Brit J Clinical Pharma

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AIMPeripheral vasoconstriction has long been described as a vascular adverse effect of β-adrenoceptor blockers. Whether β-adrenoceptor blockers should be avoided in patients with peripheral vascular disease depends on pharmacological properties (e.g. preferential binding to β 1 -adrenoreceptors or intrinsic sympathomimetic activity). However, this has not been confirmed in experimental studies. We performed a network meta-analysis in order to assess the comparative risk of peripheral vasoconstriction of different β-adrenoceptor blockers. METHODWe searched for randomized controlled trials (RCTs) including β-adrenoceptor blockers that were published in core clinical journals in the Pubmed database. All RCTs reporting peripheral vasoconstriction as an adverse effect of β-adrenoceptor blockers and controls were included. Sensitivity analyses were conducted including possibly confounding covariates (latitude, properties of the β-adrenoceptor blockers, e.g. intrinsic sympathomimetic activity, vasodilation, drug indication, drug doses). The protocol and the detailed search strategy are available online (PROSPERO registry CRD42014014374). RESULTSAmong 2238 records screened, 38 studies including 57 026 patients were selected. Overall, peripheral vasoconstriction was reported in 7% of patients with β-adrenoceptor blockers and 4.6% in the control groups (P < 0.001), with heterogeneity among drugs. Atenolol and propranolol had a significantly higher risk than placebo, whereas pindolol, acebutolol and oxprenolol had not. CONCLUSIONOur results suggest that β-adrenoceptor blockers have variable propensity to enhance peripheral vasoconstriction and that it is not related to preferential binding to β 1 -adrenoceptors. These findings challenge FDA and European recommendations regarding precautions and contra-indications of use of β-adrenoceptor blockers and suggest that β-adrenoceptor blockers with intrinsic sympathomimetic activity could be safely used in patients with peripheral vascular disease. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• β-adrenoceptor blockers are known to induce peripheral vasoconstriction, probably according to their pharmacological properties (e.g. preferential binding to β1-adrenoreceptors, intrinsic sympathomimetic activity or vasodilator effect). However, this has never been confirmed in experimental studies. WHAT THIS STUDY ADDS• Our results suggest that β-adrenoceptor blockers have variable propensity to enhance peripheral vasoconstriction. Moreover, ancillary properties of β-adrenoceptor blockers widely influence this peripheral vasoconstriction: ISA and vasodilator effect are protective, whereas preferential binding to β1-adrenoreceptors does not protect from peripheral vasoconstriction.• These findings challenge FDA and French recommendations regarding precautions and contra-indications of use of β-adrenoceptor blockers, and suggest that β-adrenoceptor blockers with intrinsic sympathomimetic activity could be safely used in patients with Raynaud's phenomenon.

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Section: Discussionsupporting

confidence: 46%

Peripheral vasoconstriction induced by β‐adrenoceptor blockers: a systematic review and a network meta‐analysis

Khouri

Jouve

Blaise

et al. 2016

Brit J Clinical Pharma

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“…The prevalence was greatest on propranolol (59%) and least on oxprenolol (22%). Similarly Steiner et al (1982), who sent a questionnaire to 800 attendees of a hypertension clinic, found that treatment with adrenoreceptor antagonists increased such symptoms in men, the overall prevalence being 54%. Neither controlled trials nor questionnaires prompting patients attending special hypertension clinics can give an indication of the spontaneous reporting rate in general practice.…”

mentioning

confidence: 96%

Is the feeling of cold extremities experienced by hypertensive patients due to their disease or their treatment?

Vandenburg¹,

Evans²,

Cooper³

et al. 1984

Eur J Clin Pharmacol

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Patients with essential hypertension were interviewed prior to entering therapeutic studies in general practice. Patients' age, sex and details of antihypertensive therapy (if any) were noted, as were their spontaneously reported symptoms. Complaints of cold extremities were highest in those taking a beta-blocker (4.1%). Those untreated or taking other therapies complained less often. Those patients taking a beta-blocker with ISA complained less often (3.1%) of cold extremities than those taking a beta-blocker without ISA (5.2%).

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“…28 Another hypothesis suggests that symptoms may be caused by the decrease in cardiac output associated with cardiac b-adrenoceptor blockade. 23 This indication of an association is not likely explained by publication bias. Statistically, we did not find evidence for the publication bias in the linear regression test (P ¼ .877).…”

Section: Discussionmentioning

confidence: 92%

“…22 On the other hand, Steiner et al published late and determined a high prevalence. 23 He also investigated a large study population. Diversification of technical and clinical assessment for diagnosis of RS may be another potential matter for these findings.…”

Section: Discussionmentioning

confidence: 99%

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The Association of Raynaud Syndrome With β-Blockers

Mohokum

Hartmann

2012

Angiology

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Vasospastic disorders of the digital circulation such as the Raynaud syndrome (RS) are known side effects of treatment of β-adrenergic blockade. The prevalence of RS in patients during treatment with β-blockers is not well defined. The objective of this meta-analysis is to assess the prevalence of RS in patients receiving β-blockers. A literature search was performed for studies dealing with RS and patients receiving β-blockers. The studies provided sufficient data to estimate the prevalence of RS in patients receiving β-blockers. A total of 13 eligible studies, contributing data on 1012 individuals, were included in this meta-analysis. For RS in patients receiving β-blockers, a pooled prevalence of 14.7% (95% confidence interval 0.076-0.236) were obtained. Statistically publication bias was not present (P = .877). Despite some heterogeneity, there is a possible indication of an association between RS and patients receiving β-blockers.

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Effect of beta‐adrenoceptor antagonists on prevalence of peripheral vascular symptoms in hypertensive patients.

Cited by 9 publications

References 8 publications

Peripheral vasoconstriction induced by β‐adrenoceptor blockers: a systematic review and a network meta‐analysis

Peripheral vasoconstriction induced by β‐adrenoceptor blockers: a systematic review and a network meta‐analysis

Is the feeling of cold extremities experienced by hypertensive patients due to their disease or their treatment?

The Association of Raynaud Syndrome With β-Blockers

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