Ubbink Dirk Th, Verhaar Emma E, Lie Henk K I, Legemate Dink A
Department of Vascular surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Vasc Surg. 2003 Sep;38(3):535-40. doi: 10.1016/s0741-5214(03)00419-1.
This study was undertaken to investigate the possible negative effect of beta-blockers on skin microcirculation in patients with intermittent claudication and hypertension. Methods and materials In this clinical crossover study, 20 patients with mild to moderate hypertension, treated with long-term beta-blockade, and intermittent claudication or ischemic rest pain, underwent assessment of peripheral circulation before and after 2-week withdrawal of beta-blocking therapy and again 2 weeks after restarting therapy. Replacement therapy (calcium antagonist) was given if considered necessary to control hypertension. Skin microcirculation was assessed with three noninvasive techniques: capillary microscopy of the hallux nailfold, transcutaneous oximetry of the forefoot, and laser Doppler fluxmetry of the great toe.
Mean initial blood pressure was 163/81 mm Hg. Mean heart rate significantly increased with withdrawal of beta-blocker, from 65 bpm to 85 bpm. No significant differences in skin microcirculation and blood pressure were found between measurements obtained before, during, and after withdrawal of beta-blocking therapy. Patients experienced no change in symptoms during the study.
beta-Blockers do not appear to have a negative effect on peripheral skin microcirculation and are therefore not contraindicated to treat hypertension when intermittent claudication or ischemic rest pain is also present.
本研究旨在调查β受体阻滞剂对间歇性跛行和高血压患者皮肤微循环可能产生的负面影响。方法与材料 在这项临床交叉研究中，20例长期接受β受体阻滞剂治疗的轻至中度高血压患者，伴有间歇性跛行或缺血性静息痛，在停用β受体阻滞剂治疗2周前后以及重新开始治疗2周后接受外周循环评估。如有必要，给予替代治疗（钙拮抗剂）以控制高血压。采用三种非侵入性技术评估皮肤微循环：拇趾甲襞毛细血管显微镜检查、前足经皮血氧测定和拇趾激光多普勒血流测定。
平均初始血压为163/81 mmHg。停用β受体阻滞剂后，平均心率显著增加，从65次/分钟增至85次/分钟。在停用β受体阻滞剂治疗前、治疗期间和治疗后的测量结果之间，皮肤微循环和血压未发现显著差异。患者在研究期间症状无变化。
β受体阻滞剂似乎对外周皮肤微循环没有负面影响，因此当存在间歇性跛行或缺血性静息痛时，并非治疗高血压的禁忌药物。
