Titre
Betablockers: a retrospective study on their role in the severity and response to treatment of Martorell’s ulcers
Type
mémoire de master/maîtrise/licence
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
CLEUSIX, L.
Auteure/Auteur
Directrices/directeurs
KUONEN, F.
Directeur⸱rice
Liens vers les personnes
Liens vers les unités
Faculté
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Accepté
Date de publication
2023
Nombre de pages
26
Langue
anglais
Résumé
Background Chronic wounds represent a major health challenge. They not only have devastating consequences for patients, but also contribute to significant costs to our health care system. Martorell's ulcers (MU) are the fourth leading cause of leg ulcers of vascular origin. However, they are an often unrecognized and under-diagnosed cause, which can lead to delayed management. MU is diagnosed on the basis of clinical presentation, patient history and deep skin biopsy. The location of MU is classically in the middle third of the lateral part of the leg. Pain in the area of the ulcer and pain in general is also an important clinical sign of MU. Healing is extremely slow and response to standard treatment is typically poor. The incidence of MU is probably increasing. Indeed, morbidity and mortality related to coronary artery disease and infarction are decreasing, notably due to population screening and increased accessibility to effective antihypertensive drugs. As a consequence, late complications of primary hypertension, such as MU, may be observed more frequently. In Switzerland, the prevalence of hypertension was 17.6% in 2017 (1). As a result, a large proportion of the population could potentially develop MU in their lifetime. Betablockers, which are widely used to treat hypertension, may be associated with an increased risk of peripheral vasoconstriction that could exacerbate the lack of oxygenation and thereby worsen the ulcer. It is therefore interesting to evaluate the potential influence of betablockers on the severity of MU and the response to treatment. It could therefore challenge the drugs used to treat hypertension and have an impact not only on the severity and response to treatment of these ulcers, but also on patients’ pain and costs.

3
Objective The objective of this exploratory study is to evaluate the severity of MU according to the use or not of betablockers in patients with MU followed in the dermatology department of the Lausanne University Hospital CHUV. The primary objective of this study is to determine if the severity of MU can be correlated with the presence of an antihypertensive treatment such as betablockers. The secondary objective is to evaluate if there is an influence of betablockers on the response to the treatment classically used to treat MU.
Methods Clinical data collected between 2014 and 2021 includes age at diagnosis, gender, history, length of hospitalization, antihypertensive treatment and ulcer characteristics (date and circumstances of onset, location, local treatment, surface area by length and width, count, ...). Patients were separated into two groups: patients treated with betablockers for their hypertension and patients not treated with betablockers.
Results The most relevant finding of our research is a significant difference in opioid use between the two groups (p-value: 0,00782) (Table 2). Opioids were prescribed for pain management in 50% of the patients with betablockers and 5,88% in those without betablockers, indicating a positive correlation between betablocker usage and the severity of pain. Additionally, when considering all types of pain medication except opiates, even though the discrepancy is not significant, patients taking betablockers use a higher proportion of analgesic medication compared to the other group (BB: 70 %, NBB: 52,94%, p-value: 0,3843). In contrast, use of paracetamol (p-value: 0,88076), paracetamol with codeine (p-value: 0,18352) and metamizole sodium monohydrate (p-value: 0,4354) is comparable in group 1 and 2.
  
4
The mean number of ulcerations per patient shows a tendency for ulcers to be more numerous in patients with betablockers, although the difference was not significant. Patients who are taking betablockers tend to exhibit a tendency towards larger size. However, the observed difference in size was not statistically significant. With regards to therapeutic intervention, there was no significant difference in the proportion of those who underwent a thin skin thickness graft (BB: 70%, NBB: 70,59%, p-value: 0,97606). The same is true for people who had a graft only without ulcer excision (BB: 40%, NBB: 47,06%, p-value: 0,71884) and those who received conservative treatment only (BB: 30%, NBB: 29,41%, p-value: 0,97606).
The delay between the appearance of the ulcers and the first consultation was shorter in patients of group 1 (BB: 97,57 days, NBB: 300,58 days, p-value: 0,210), although not significant. The same goes for the delay between appearance and grafting (BB: 174,14 days, NBB: 396,83 days, p-value: 0,196). The delay between the first consultation and grafting does not vary much between both groups (77,43 days vs 50,58 days, p-value 0,127).
Regarding evolution more people experience overall relapse if they are treated with betablockers (BB: 30%, NBB: 23,53%, p-value: 0,71138), but the difference isn’t significant. Short-term relapse is equally prevalent in both groups (BB: 20%, NBB: 17,65%, p-value: 0,88076), whereas long-term relapse is more often found in group 1 (BB: 10%, NBB: 5,88%, p-value: 0,69654), without a significant difference.
Conclusion Our results highlight a greater use of opiates in patients treated with betablockers, which suggests a higher level of pain in this group and therefore more severe ulcers.

3
Objective The objective of this exploratory study is to evaluate the severity of MU according to the use or not of betablockers in patients with MU followed in the dermatology department of the Lausanne University Hospital CHUV. The primary objective of this study is to determine if the severity of MU can be correlated with the presence of an antihypertensive treatment such as betablockers. The secondary objective is to evaluate if there is an influence of betablockers on the response to the treatment classically used to treat MU.
Methods Clinical data collected between 2014 and 2021 includes age at diagnosis, gender, history, length of hospitalization, antihypertensive treatment and ulcer characteristics (date and circumstances of onset, location, local treatment, surface area by length and width, count, ...). Patients were separated into two groups: patients treated with betablockers for their hypertension and patients not treated with betablockers.
Results The most relevant finding of our research is a significant difference in opioid use between the two groups (p-value: 0,00782) (Table 2). Opioids were prescribed for pain management in 50% of the patients with betablockers and 5,88% in those without betablockers, indicating a positive correlation between betablocker usage and the severity of pain. Additionally, when considering all types of pain medication except opiates, even though the discrepancy is not significant, patients taking betablockers use a higher proportion of analgesic medication compared to the other group (BB: 70 %, NBB: 52,94%, p-value: 0,3843). In contrast, use of paracetamol (p-value: 0,88076), paracetamol with codeine (p-value: 0,18352) and metamizole sodium monohydrate (p-value: 0,4354) is comparable in group 1 and 2.
  
4
The mean number of ulcerations per patient shows a tendency for ulcers to be more numerous in patients with betablockers, although the difference was not significant. Patients who are taking betablockers tend to exhibit a tendency towards larger size. However, the observed difference in size was not statistically significant. With regards to therapeutic intervention, there was no significant difference in the proportion of those who underwent a thin skin thickness graft (BB: 70%, NBB: 70,59%, p-value: 0,97606). The same is true for people who had a graft only without ulcer excision (BB: 40%, NBB: 47,06%, p-value: 0,71884) and those who received conservative treatment only (BB: 30%, NBB: 29,41%, p-value: 0,97606).
The delay between the appearance of the ulcers and the first consultation was shorter in patients of group 1 (BB: 97,57 days, NBB: 300,58 days, p-value: 0,210), although not significant. The same goes for the delay between appearance and grafting (BB: 174,14 days, NBB: 396,83 days, p-value: 0,196). The delay between the first consultation and grafting does not vary much between both groups (77,43 days vs 50,58 days, p-value 0,127).
Regarding evolution more people experience overall relapse if they are treated with betablockers (BB: 30%, NBB: 23,53%, p-value: 0,71138), but the difference isn’t significant. Short-term relapse is equally prevalent in both groups (BB: 20%, NBB: 17,65%, p-value: 0,88076), whereas long-term relapse is more often found in group 1 (BB: 10%, NBB: 5,88%, p-value: 0,69654), without a significant difference.
Conclusion Our results highlight a greater use of opiates in patients treated with betablockers, which suggests a higher level of pain in this group and therefore more severe ulcers.
PID Serval
serval:BIB_04A845E819E3
Date de création
2024-07-25T06:13:20.939Z
Date de création dans IRIS
2025-05-20T19:29:41Z
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