From the Guidelines
Metoprolol can cause vascular issues in some patients, particularly those with pre-existing peripheral artery disease or Raynaud's phenomenon, due to its potential to cause peripheral vasoconstriction and reduce blood flow to extremities. This beta-blocker medication, commonly used to treat high blood pressure, heart failure, and angina, works by blocking beta-adrenergic receptors, which reduces heart rate and cardiac output, but this mechanism can also affect blood vessel tone 1. Patients with existing vascular conditions should be monitored closely when taking metoprolol, typically prescribed at doses ranging from 25-100 mg twice daily for hypertension.
Some key points to consider when prescribing metoprolol to patients with vascular conditions include:
- Monitoring for signs of peripheral vasoconstriction, such as cold extremities or worsening claudication symptoms
- Adjusting the dosage or switching to alternative medications if vascular symptoms develop or worsen
- Considering the use of alternative antianginal medications, such as ivabradine, ranolazine, or trimetazidine, in patients with peripheral artery disease or chronic stable angina 1
- Avoiding the use of vasodilators, such as calcium-channel blockers and nitrates, in patients with critical ischemia, as they can cause acute blood-pressure lowering and worsen outcomes 1
It's also important to note that the evidence on the use of beta-blockers in patients with peripheral artery disease is limited, and more research is needed to fully understand the potential risks and benefits of metoprolol in this population 2, 3. However, based on the available evidence, it's clear that metoprolol can cause vascular issues in some patients, and careful monitoring and management are necessary to minimize these risks.
From the FDA Drug Label
ADVERSE REACTIONS ... Cardiovascular ... Cold extremities; arterial insufficiency, usually of the Raynaud type; ... Gangrene in patients with pre-existing severe peripheral circulatory disorders has also been reported very rarely ...
Vascular issues with metoprolol can occur, including:
- Cold extremities
- Arterial insufficiency (usually of the Raynaud type)
- Gangrene in patients with pre-existing severe peripheral circulatory disorders (very rare) 4
From the Research
Vascular Issues with Metoprolol
- Metoprolol, a beta-blocker, is generally well tolerated and its beta 1-selectivity may facilitate its administration to certain patients, such as asthmatics and diabetics, in whom non-selective beta-blockers are contraindicated 5.
- Studies have shown that metoprolol can be used in patients with peripheral vascular disease (PVD) without significant adverse effects on peripheral circulation 6.
- In fact, metoprolol has been shown to increase the pain-free walking distance in patients with intermittent claudication, a symptom of PVD 6.
- However, other studies have suggested that metoprolol may reduce hyperaemic flow in patients with intermittent claudication, which could potentially worsen vascular issues 7.
- The effects of metoprolol on vascular resistance and blood flow are complex and may depend on various factors, such as the dose and duration of treatment, as well as individual patient characteristics 8, 7.
- Overall, the evidence suggests that metoprolol can be used safely in patients with vascular issues, but careful monitoring and individualized treatment are necessary to minimize potential adverse effects 5, 6, 8, 7.
- It is also important to note that metoprolol is not contraindicated in patients with intermittent claudication, and its use may be beneficial in certain cases 6.
- The comparison of metoprolol with other antihypertensive drugs, such as calcium-channel blockers, has shown that metoprolol may have different effects on vascular resistance and blood flow 8.