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Updated: Apr 6, 2026
Assessing Endothelial Vasodilator Function with the Endo-PAT 2000
Published on: October 15, 2010
Influence of beta-blockers on endothelial function: A meta-analysis of randomized controlled trials
Michał Peller, Krzysztof Ozierański, Pawel Balsam1
11st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. pawel.balsam@me.com.
Insights
Beta-blockers improve endothelial function, particularly third-generation ones, compared to placebo. Their effect on flow-mediated dilation (FMD) is comparable to ARBs, CCBs, and diuretics, but less than ACE inhibitors.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Biology
Background:
- Endothelial dysfunction (ED) is a precursor to cardiovascular diseases (CVD) and a risk factor for major adverse cardiac events.
- Beta-blockers are primary treatments for CVD.
Purpose of the Study:
- To systematically evaluate the impact of beta-blockers on endothelial function, measured by flow-mediated dilation (FMD).
- To compare the efficacy of different generations of beta-blockers and other cardiovascular drugs on endothelial function.
Main Methods:
- Systematic literature search of randomized controlled trials in PubMed and Cochrane Databases.
- Analysis included 16 studies with 1,273 patients, assessing FMD changes.
Main Results:
- Beta-blockers significantly improved FMD compared to placebo (MD 0.83, p=0.02).
- Third-generation beta-blockers showed a greater improvement in FMD than second-generation ones (MD 1.65, p=0.03).
- Beta-blockers had similar effects to ARBs, CCBs, and diuretics, but a lesser effect than ACE inhibitors on FMD.
Conclusions:
- Beta-blockers enhance endothelial function versus placebo.
- Third-generation beta-blockers offer superior FMD improvement compared to second-generation agents.
- The impact of beta-blockers on endothelial function is comparable to ARBs, CCBs, and diuretics, but less than ACE inhibitors.
Background:
Endothelial dysfunction (ED) frequently precedes cardiovascular diseases (CVD) and is a well-established risk factor of major adverse cardiac events. Beta-blockers are the fundamental drugs used in CVD treatment.
Methods:
A systematic literature search for randomized controlled trials investigating influence of beta-blockers on endothelial function assessed by flow-mediated dilation (FMD) was performed in the PubMed and Cochrane Databases.
Results:
Sixteen full-text studies involving a total of 1,273 patients were included in the final analysis. The mean age of participating patients ranged from 44.9 to 63.2 years, the follow-up duration from 1 to 12 months. The comparison of FMD change between the beta-blockers and placebo groups showed a statistically significant effect of beta-blockers on endothelial function (mean difference [MD] 0.83; 95% confidence interval [CI] 0.11-1.55; p = 0.02). Third generation beta-blockers improved FMD in a statistically significant manner compared with second generation beta-blockers (MD 1.65; 95% CI 0.17-3.11; p = 0.03). Beta-blockers gave an FMD change similar to that obtained with angiotensin receptor blockers (ARB), calcium channel blockers (CCB) or hydrochlorothiazide. The FMD value in the beta-blocker group was significantly lower compared with the group treated with angiotensin converting enzyme inhibitors (ACEI) (MD -0.79; 95% CI -1.37-(-0.21); p = 0.008) and higher than in the ivabradine group (1.6 ± 3.61 vs -0.3 ± 1.66; p = 0.02).
Conclusions:
Beta-blockers improve the endothelial function compared with placebo. More-over, third generation beta-blockers improve FMD values significantly better than the second generation ones. Beta-blockers had similar effect on endothelial function as did ARB, CCB or diuretics. However, the beneficial effect of beta-blockers was lower when confronted with ACEI.
