Understanding if Does Bisoprolol Cause Poor Circulation and How to Manage It

October 10, 2025 •

3 min read

Reports suggest that a common side effect of beta-blockers like bisoprolol is cold hands and feet. Does bisoprolol cause poor circulation, and what should patients know about this potential risk? Bisoprolol's impact on blood flow is a complex topic related to its mechanism of action, patient health, and dosage.

Quick Summary

Bisoprolol, a beta-blocker, can lead to symptoms of poor circulation like cold hands and feet due to reduced cardiac output. While its B1-selective action is generally less likely to cause this than non-selective alternatives, caution is advised for those with pre-existing vascular conditions. Management involves monitoring symptoms, dosage adjustments, and lifestyle changes.

Key Points

Circulatory Side Effects Possible: Bisoprolol, like other beta-blockers, can cause symptoms of poor circulation, including cold hands and feet, due to reduced cardiac output.
Less Risk than Non-Selectives: As a beta-1 selective blocker, bisoprolol has a lower risk of aggravating peripheral circulation issues compared to non-selective beta-blockers, which can cause more significant vasoconstriction.
Risks for Pre-Existing Conditions: Patients with pre-existing conditions such as peripheral vascular disease (PVD) or Raynaud's syndrome should be cautious, as bisoprolol can worsen their symptoms.
Dosage Matters: At higher doses, bisoprolol can lose its selectivity and block beta-2 receptors, increasing the likelihood of poor circulation symptoms.
Management is Key: Symptoms can often be managed through simple measures like keeping extremities warm and avoiding smoking or caffeine. Consultation with a doctor is necessary for persistent issues.
Professional Guidance is Vital: Any changes to medication or ongoing concerns about circulatory symptoms should be discussed with a healthcare professional to ensure safety and effectiveness.

Bisoprolol is a beta-blocker medication commonly prescribed to treat conditions such as high blood pressure (hypertension), angina (chest pain), and chronic heart failure. It works by targeting specific receptors in the heart to slow the heart rate and reduce the force of its contractions. This action helps to lower blood pressure and decrease the heart's workload. While effective for these conditions, a recognized side effect is the potential for worsened circulation in the extremities, a concern that raises the question: Does bisoprolol cause poor circulation?

The Mechanism Behind Bisoprolol's Effect

Bisoprolol primarily blocks beta-1 receptors in the heart, slowing heart rate and reducing contraction force. This reduces the heart's overall output, lowering blood pressure and the heart's workload. However, this reduced output also means less blood reaching the extremities, potentially causing cold hands and feet, tingling, or numbness.

Bisoprolol vs. Non-Selective Beta-Blockers

Bisoprolol is a beta-1 selective blocker, primarily affecting heart receptors, unlike non-selective beta-blockers that also block beta-2 receptors in blood vessels. Blocking beta-2 receptors causes vasoconstriction, increasing the risk of circulation problems. Bisoprolol generally has a lower risk of these issues due to its selectivity. However, at higher doses, bisoprolol can lose its selectivity and affect beta-2 receptors, increasing the risk of circulatory effects.

Comparison Table: Bisoprolol vs. Non-Selective Beta-Blockers


Feature	Bisoprolol (Beta-1 Selective)	Non-Selective Beta-Blockers (e.g., Propranolol)
Target Receptors	Primarily Beta-1 (heart)	Both Beta-1 (heart) and Beta-2 (periphery)
Effect on Heart Rate	Decreases (Negative Chronotropic Effect)	Decreases (Negative Chronotropic Effect)
Effect on Cardiac Output	Decreases	Decreases
Effect on Peripheral Vessels	Minimal effect at therapeutic doses	Vasoconstriction due to Beta-2 blockade
Risk of Poor Circulation	Lower risk, often less severe symptoms	Higher risk, potentially more severe symptoms
Dosage Consideration	Higher doses may lose selectivity	Selectivity not a factor for dose-related risk

Who is at Risk for Bisoprolol-Induced Circulation Issues?

Individuals with pre-existing conditions are at higher risk. Bisoprolol can worsen symptoms in patients with Peripheral Vascular Disease (PVD). It should be avoided by those with severe blood circulation problems like Raynaud's syndrome, as it can aggravate symptoms. Higher doses of bisoprolol also increase the risk of affecting beta-2 receptors and causing vasoconstriction.

Managing and Addressing Circulation Side Effects

If you experience circulatory side effects, consult your healthcare provider. Non-medical management includes keeping extremities warm, using warm water, massaging and moving fingers and toes, and avoiding smoking and caffeine. If symptoms persist or worsen, or if you have pre-existing vascular issues, speak with your doctor. Dosage adjustment or switching to an alternative medication may be considered.

What the Studies Say

Research on beta-blockers and peripheral circulation, particularly in patients with peripheral arterial disease (PAD), has had mixed results. Some studies suggest no adverse effect on walking distance in intermittent claudication, while others advise caution, especially in severe PAD. Newer beta-blockers with vasodilating properties show promise but require more research.

Conclusion

While not a direct cause of vascular disease, bisoprolol can contribute to symptoms of poor circulation like cold extremities by slowing the heart and decreasing blood flow to the body's outer areas. This risk is generally lower than with non-selective beta-blockers but increases with higher doses. Patients with conditions like PVD or Raynaud's are more vulnerable and require close medical supervision. If you experience persistent circulatory symptoms, consult your healthcare provider to discuss management strategies, including potential dosage adjustments or medication changes.

For more detailed information, consult the patient information leaflet for Bisoprolol fumarate.

Frequently Asked Questions

The primary reason bisoprolol can cause poor circulation symptoms is its effect of slowing the heart rate and reducing the force of heart contractions. This leads to decreased cardiac output, meaning less blood is pumped to the extremities, such as the hands and feet.

Generally, no. As a beta-1 selective blocker, bisoprolol has a lower risk of causing circulatory side effects compared to non-selective beta-blockers, which can cause more pronounced constriction of peripheral blood vessels.

You should use bisoprolol with caution if you have PVD, and only under a doctor's supervision. Beta-blockers, including bisoprolol, can worsen symptoms of arterial insufficiency in patients with pre-existing peripheral vascular disease.

Higher doses of bisoprolol (above 20 mg/day) can cause the medication to lose its beta-1 selectivity and start blocking beta-2 receptors, which increases the risk of aggravating circulation problems.

You can try keeping your extremities warm with gloves or socks, exercising regularly, and avoiding smoking and caffeine, which can constrict blood vessels. If symptoms persist, consult your doctor for advice on potential dosage adjustments or alternative treatments.

You should contact your doctor if your circulatory symptoms, such as coldness, numbness, or tingling in your hands and feet, are persistent, worsening, or significantly affecting your quality of life. This is especially important for those with pre-existing vascular conditions.

No, you should never stop taking bisoprolol suddenly without consulting your doctor. Abrupt discontinuation, especially for those with coronary artery disease, can worsen heart conditions and cause serious complications.