There is no convincing evidence that peripheral
vasodilators produce any significant improvement in exercise tolerance in patients with
peripheral vascular disease, and these drugs may do more harm than good. In the treatment of severe Raynaud's syndrome, however,
thymoxamine,
prazosin or
nifedipine is recommended. A descriptive study was carried out, firstly, to determine why these drugs are prescribed in general practice, and secondly, to describe the
drug choices in the treatment of both Raynaud's syndrome and
peripheral vascular disease in a representative sample of 22 practices in Northern Ireland. Of those patients prescribed peripheral
vasodilators 69.6% were diagnosed as
peripheral vascular disease, claudication or
atherosclerosis. Over three-quarters of peripheral
vasodilators prescribed were repeat prescriptions. Of those with Raynaud's syndrome only half were treated appropriately, and certainty of diagnosis did not guarantee appropriate treatment. Peripheral
vasodilators accounted for the majority (51.5%) of items prescribed for
peripheral vascular disease. A minority of patients with
peripheral vascular disease (20.3%) were prescribed
aspirin, and a smaller minority (4.4%) had undergone
amputation. Peripheral
vasodilators were prescribed unnecessarily and inappropriately. Measures to promote evidence-based treatment of both Raynaud's syndrome and
peripheral vascular disease in general practice need to be taken.