From the Guidelines
Metoprolol can be used in patients with Peripheral Vascular Disease (PVD), but with caution and careful monitoring, as studies have shown that beta-blockers, including metoprolol, are safe in patients with intermittent claudication (IC) without negative effects on walking distance (WD) 1. When considering the use of metoprolol in PVD patients, it is essential to weigh the potential benefits against the risks. The 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases suggest that beta-blockers, such as metoprolol, can be used in patients with LEAD, especially those with comorbidities like heart failure 1. Key points to consider when using metoprolol in PVD patients include:
- Starting with a low dose (e.g., 25 mg twice daily) and titrating carefully while monitoring for signs of reduced peripheral perfusion 1
- Preferably using cardioselective beta-blockers like metoprolol, which have less effect on peripheral vasculature at lower doses 1
- Considering alternative antihypertensive medications like calcium channel blockers or ACE inhibitors, which may be better first-line choices for patients with significant PVD 1
- Regularly assessing the patient's walking distance and overall clinical outcome to ensure that metoprolol is not exacerbating their PVD symptoms 1.
From the Research
Use of Metoprolol in Peripheral Vascular Disease (PVD)
- Metoprolol, a beta blocker, has been studied in patients with PVD to assess its effects on peripheral circulation and symptoms of intermittent claudication 2, 3, 4, 5.
- The studies suggest that metoprolol, as a beta 1-selective beta blocker, does not worsen symptoms of intermittent claudication and may even improve pain-free walking distance in patients with PVD 2, 4.
- A Cochrane review of six randomized controlled trials, including those using metoprolol, found no statistically significant worsening effect of beta blockers on time to claudication, claudication distance, and maximal walking distance, as well as on calf blood flow, calf vascular resistance, and skin temperature 3, 5.
- Another study recommends the use of beta blockers, including metoprolol, in patients with PVD and coronary artery disease, as they can help manage hypertension and reduce the risk of cardiovascular events 6.
Key Findings
- Metoprolol does not adversely affect peripheral circulation in patients with PVD 2, 4.
- Beta blockers, including metoprolol, do not worsen symptoms of intermittent claudication in patients with PVD 3, 5.
- The use of beta blockers, including metoprolol, may be beneficial in patients with PVD and coronary artery disease 6.