Peripheral vascular effects of beta-blockers

This review addresses the vascular effects of beta-blockers in patients with normal peripheral circulation, with hypertension or with peripheral arterial disease. Despite conflicting data from many uncontrolled and relatively small studies some general conclusions can be drawn. In the absence of peripheral vascular disease there is no good evidence of any adverse effects of beta-blocker treatment on peripheral circulation. Nevertheless, it may be useful to change from non-selective to beta-1 selective beta-blockers or to beta-blockers with ISA when patients complain of cold extremities. In hypertensive patients, beta-blocker therapy may similarly cause cold extremities, especially with non-selective beta-blockade. Successful long-term antihypertensive treatment, as with beta-blockers, may restore normal vascular architecture. In patients suffering from peripheral arterial disease, beta-blockers are not generally contraindicated although they should be administered with extreme caution when disease is severe. In less severe forms of occlusive disease, beta-blockers have little effect on peripheral circulation and may even improve flow to the diseased area by an inverse steal effect.