β-Adrenergic blockers have been considered relatively contraindicated in peripheral arterial disease because of the perceived risk that these drugs could worsen intermittent claudication. Therefore, we conducted a meta-analysis of available randomized controlled trials from the English-language literature to determine whether or not β-blockers exacerbate intermittent claudication. The primary focus of this analysis was the effect of β-blockers on exercise dura tion, measured as walking capacity or endurance time. Outcomes were pooled where appropriate. Of 11 eligible reports, six included 11 individual controlled treatment comparisons that provided data for an analysis of pain-free exercise capacity; no effect size was statistically significant. The pooled effect size for pain-free walking distance was -0.24 (95% confidence interval, -0.62 to 0.14), indicat ing no significant impairment of walking capacity compared with placebo. Only one study reported that certain β-blockers were associated with worsening of intermittent claudication. These results strongly suggest that β-blockers do not adversely affect walking capacity or symptoms of intermittent claudication in patients with mild to moderate peripheral arterial disease. In the absence of other con traindications, β-blockers can probably be used safely in such patients.
(Arch Intern Med. 1991;151:1769-1776)