Effect of beta-blockers on peripheral skin microcirculation in hypertension and peripheral vascular disease.
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.
Ubbink
Dirk Th
DT
Department of Vascular surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. D.Ubbink@amc.uva.nl
Verhaar
Emma E
EE
Lie
Henk K I
HK
Legemate
Dink A
DA
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
D000319:Adrenergic beta-Antagonists