CLINICAL INVESTIGATION Effects of /3-adrenoreceptor-blocking drugs in patients with Raynaud's phenomenon

Digital vasospastic phenomena have been reported to result from use of nonselective and cardioselective /3-adrenoreceptor-blocking drugs. The effects of 80 mg/day propranolol and 100 mg/day metoprolol on finger hemodynamics and clinical responses were compared with those of placebo in 16 patients with Raynaud's phenomenon. A double-blind, 2 week crossover study design was used with a 2 week washout placebo period between drugs. Total fingertip blood flow (FBF) as determined by venous occlusion plethysmography, fingertip capillary flow (FCF) as determined by radioisotope disappearance rate, and finger systolic blood pressure (FSP) were measured in a 28.3° and a 20° C room at the end of each period. Subjects kept diaries to record vasospastic attacks. There were no significant changes in FBF, FCF, or FSP in the warm or cool environment during drug treatment as compared with during the placebo period. A decrease in pulse rate occurred with both drugs and there was a decrease in blood pressure with metoprolol. There were no significant changes in the number of vasospastic attacks or in the patients' overall evaluation of their conditions while they were receiving the drugs. It is concluded that the presence of Raynaud's phenomenon is not a contraindication to the use of ,3-adrenoreceptor-blocking drugs in the normotensive population. Circulation 72, No. 3, 466-470, 1985. USE OF (3-adrenoreceptor-blocking drugs has been associated with the development of Raynaud's phenomenon, cold extremities, and intermittent claudication. The mechanism of action is unknown. Unopposed stimulation of vascular ca-adrenoreceptors, decreased cardiac output and blood pressure resulting in lower perfusion pressure and blood flow, a decreased blood volume, or increased reflex sympathetic vasoconstriction by the central cardiovascular depressant effects of /3-blockade have been suggested. `4 /3Adrenoreceptors have been shown to be present in the arteriovenous anastomoses of the fingers. They are only responsive to humoral agents and not to neurogenic stimulation, but could be involved in the development of Raynaud's phenomenon.) Vasospastic phenomenon have been described with use of both nonselective and cardioselective agents1 6 and cardioselective agents have been shown to affect the peripheral circulation.7 Since these agents must sometimes be used in patients with Raynaud's phenomenon and From the Peripheral Vascular Section. Evans Memorial Department of Clinical Research, Department of Medicine, University Hospital, Boston University Medical Center. Supported by National Institutes of Health grant HL 26320 and CibaGeigy Pharmaceuticals, Summit, NJ. Address for correspondence: Jay D. Coffman. M.D., University Hospital, 75 E. Newton St., Boston, MA 02118. Received April 1. 1985; revision accepted May 23. 1985. coronary artery disease, we investigated the effect of a cardioselective and a nonselective /3-blocking drug in equivalent doses on fingertip hemodynamics and clinical symptoms in patients with Raynaud's phenomenon.