Beta-blockers can be used with caution in peripheral arterial disease

Clinical question: 
What are the potential harms of using beta-blockers in patients with peripheral arterial disease (PAD)?
Bottom line: 
None of the trials reviewed showed a clear worsening effect of beta-blockers on time to claudication, claudication and maximal walking distances measured on a treadmill, calf blood flow, calf vascular resistance and skin temperature when compared with placebo. The trials did not report any adverse events or issues regarding taking the medication with the beta-blockers studied (atenolol, propranolol, pindolol and metoprolol). Beta-blockers should be used with caution in PAD if clinically indicated.
Caveat: 
Most of the trials were over 10 years old, reported on between 1980 and 1991. All were small and of poor quality. The drugs were administered for a short period of time (10 days to 2 months) and most of the outcome measures were reported in single studies. Additional drugs, calcium channel blockers and combined alpha and beta-blockers, were also given in some of the trials.
Context: 
Beta-blockers have been shown to decrease mortality in people with high blood pressure and coronary artery disease. Optimal therapy for people with either coronary artery disease or hypertension and PAD is controversial. This is because of the presumed peripheral blood flow consequences of beta-blockers, leading to worsening of symptoms.
Review CD#: 
CD005508
PEARLS No: 
127
Date: 
October, 2008
Authored by: 
Brian R McAvoy