Patients undergoing vascular surgery comprise a group at elevated risk of fatal and nonfatal perioperative cardiovascular events. In four recent longitudinal studies, the 30-day incidence of death in such patients was 3% to 6%, and the incidence of myocardial infarction was 5% to 14%. Growing evidence suggests that beta-adrenergic receptor antagonists prevent cardiovascular morbidity and mortality in high-risk patients undergoing noncardiac surgery, including those undergoing vascular surgery. This article reviews the available evidence concerning beta-blockers and provides guidance for their use in the perioperative setting.