Question

Propranolol is indicated in the following conditions EXCEPT

• A. Intermittent claudication
• B. Portal hypertension
• C. Migraine
• D. Benign essential tremors

Hint:

Think about which condition involves already-reduced blood flow to a limb that beta-2 blockade would worsen.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
The question asks which of the listed conditions is NOT an indication for propranolol, a non-selective beta blocker used across cardiovascular, neurological, and gastrointestinal contexts.

Step 2: Key Concept or Approach:
Propranolol blocks both beta-1 and beta-2 receptors. Its beta-2 blockade is helpful in some settings, such as reducing portal pressure by causing splanchnic vasoconstriction, but it is harmful in conditions where peripheral blood flow is already compromised, because it removes the beta-2-mediated vasodilation that partially compensates for arterial insufficiency.

Step 3: Working Through the Options:
Portal hypertension is a validated indication: non-selective beta blockers like propranolol reduce portal venous pressure and are used for primary and secondary prophylaxis of variceal bleeding. Migraine prophylaxis is another accepted use of propranolol, thought to work through central beta-blockade effects. Benign essential tremor also responds well to propranolol, which reduces the peripheral beta-2-mediated component of the tremor. Intermittent claudication is different — it is caused by peripheral arterial insufficiency, and non-selective beta blockade removes beta-2 vasodilation while leaving alpha-mediated vasoconstriction unopposed, which can further reduce limb blood flow and worsen claudication symptoms. For this reason, beta blockers are used cautiously or avoided in patients with significant peripheral vascular disease.

Step 4: Conclusion:
Intermittent claudication is the condition where propranolol is not indicated and can even worsen symptoms, making it the correct answer.