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[Are beta-blockers generally contraindicated in patients with peripheral arterial occlusive disease?]
J Schweizer1, R Kaulen, E Altmann
1II. Medizinische Klinik, Städtisches Klinikum Dresden-Friedrichstadt.
Insights
Celiprolol and isosorbide dinitrate improved peripheral arterial blood flow in patients with heart disease and peripheral arterial occlusive disease, unlike atenolol. Celiprolol offers a vasodilatory effect beneficial for patients with impaired arterial perfusion.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic ischemic heart disease and peripheral arterial occlusive disease (PAOD) significantly impair quality of life.
- Evaluating medication effects on peripheral circulation is crucial for managing these conditions.
Purpose of the Study:
- To investigate the impact of celiprolol, atenolol, and isosorbide dinitrate on peripheral arterial blood flow in patients with PAOD.
- To compare these effects against placebo and identify potential therapeutic benefits.
Main Methods:
- Ninety patients with chronic ischemic heart disease and stage IIb PAOD were randomized.
- Medications (celiprolol, atenolol, isosorbide dinitrate) or placebo were administered for 3 months.
- Peripheral arterial blood flow was assessed via walking distance and femoral artery resistance index using Doppler sonography.
Main Results:
- Atenolol (50 mg/day) significantly reduced walking distance and increased femoral artery resistance index.
- Celiprolol (200 mg/day) and isosorbide dinitrate (80 mg/day) did not alter walking distance compared to placebo.
- Both celiprolol and isosorbide dinitrate significantly decreased femoral artery resistance index, indicating improved blood flow.
Conclusions:
- Celiprolol demonstrates a vasodilatory action, similar to nitrates, beneficial for patients with chronic ischemic heart disease and PAOD.
- Celiprolol is a potential therapeutic option for improving peripheral arterial perfusion in this patient population.
- Atenolol may negatively impact peripheral arterial circulation in patients with PAOD.
Abstract:
Ninety patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease were investigated to determine the effect of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial blood flow. Walking distance and the resistance index in the femoral artery were measured before and after 3 months medication and compared with the findings in controls (30 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease) who received placebo. Patients with peripheral arterial occlusive disease who were treated with atenolol 50 mg/day demonstrated significant decreases in both pain-free and maximal walking distance. In contrast, the walking distances in those given celiprolol 200 mg/day and those who received isosorbide dinitrate 80 mg/day did not differ from the distances in control subjects. The Doppler flow through the femoral artery, as measured by color duplex sonography, showed a significant decrease in resistance index, both in patients given celiprolol and in those given isosorbide dinitrate. In patients treated with atenolol the resistance index rose significantly. The results of this study confirm that the beta-adrenoceptor blocker celiprolol exerts a supplementary vasodilatory action resembling that of nitrates and hence can be used in patients with chronic ischemic heart disease and impaired peripheral arterial perfusion.