Beta blockers have some difficulties in proving their efficiency and for instance, everyone recalled the false advice to favor a BB prescription before non-cardiac surgery in vascular patients.
Concerning side effects, it is an empirical experience that in some vascular patients with PAD walking distance is reduced when a BB are added to the list. This is still controversial but it is a common experience among cardiovascular specialists. Usually, those patients are in a fragile hemodynamic equilibrium but their experience is actual.
Erectile dysfunction is a major problem in CVD patients which is largely unappreciated au motif que: "I saved your life with a successful PCI procedure"... Young male CVD patients frequently complain about ED after treatments and especially beta blockers. I admit that there is a place for bias because, in those patients, several drugs (and diabetes) could alter the fragile mechanism of NO secretion in the cavernous muscle which leads to muscle relaxation and erection.
My clinical experience is that it is far more frequent than advertised and more importantly that is very difficult to reverse the situation if BB are not stopped early.
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