title: Effect of beta-blockers on peripheral skin microcirculation in hypertension and peripheral vascular disease.
abstract: OBJECTIVE
  This study was undertaken to investigate the possible negative effect of beta-blockers on skin microcirculation in patients with intermittent claudication and hypertension. Methods and materials In this clinical crossover study, 20 patients with mild to moderate hypertension, treated with long-term beta-blockade, and intermittent claudication or ischemic rest pain, underwent assessment of peripheral circulation before and after 2-week withdrawal of beta-blocking therapy and again 2 weeks after restarting therapy. Replacement therapy (calcium antagonist) was given if considered necessary to control hypertension. Skin microcirculation was assessed with three noninvasive techniques: capillary microscopy of the hallux nailfold, transcutaneous oximetry of the forefoot, and laser Doppler fluxmetry of the great toe.
  
  
  RESULTS
  Mean initial blood pressure was 163/81 mm Hg. Mean heart rate significantly increased with withdrawal of beta-blocker, from 65 bpm to 85 bpm. No significant differences in skin microcirculation and blood pressure were found between measurements obtained before, during, and after withdrawal of beta-blocking therapy. Patients experienced no change in symptoms during the study.
  
  
  CONCLUSIONS
  beta-Blockers do not appear to have a negative effect on peripheral skin microcirculation and are therefore not contraindicated to treat hypertension when intermittent claudication or ischemic rest pain is also present.
authors.affiliation: Department of Vascular surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. D.Ubbink@amc.uva.nl
authors.forename: Dirk Th
authors.initials: DT
authors.lastname: Ubbink
authors.forename: Emma E
authors.initials: EE
authors.lastname: Verhaar
authors.forename: Henk K I
authors.initials: HK
authors.lastname: Lie
authors.forename: Dink A
authors.initials: DA
authors.lastname: Legemate
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001785:Blood Gas Monitoring, Transcutaneous; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D007383:Intermittent Claudication / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D020678:Microscopic Angioscopy; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D018570:Risk Assessment; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply* / Q000187:drug effects; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists