A Cochrane review [Abstract] 1 included 6 studies with a total of 119 subjects. Most of the included patients suffered from either mild or moderate peripheral vascular disease. Studies using selective beta blockers (atenolol, metoprolol) and non-selective beta blockers (propranolol, pindolol) were included. The drugs were administered for a short period of time (10 days to two months), and additional drugs, calcium channel blockers and combined alpha and beta blockers, were also given in some of the trials. Most of the outcome measures were reported in single studies, and thus a meta-analysis was not performed. None of the trials 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.
An RCT 2 included a total of 128 subjects with intermittent claudication and essential hypertension. Nebivolol 5 mg was compared with 95 mg of metoprolol for 48 week treatment period. Ankle-brachial index (ABI) and absolute claudication distance improved significantly in both patient groups (P<0.05 for both), with no difference across treatments. A significant increase of initial claudication distance was found in the nebivolol group (adjusted mean change of initial claudication distance was 34% after nebivolol (P=0.003) and 17% after metoprolol (P=0.12)).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (limited study size for each comparison).
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