Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Correlation between propranolol in plasma and urine, renin-aldosterone system and blood pressure in essential hypertension

  • 34 Accesses

  • 5 Citations

Summary

Thirty patients with mild or moderate essential hypertension, and a fixed elevation of diastolic blood pressure, were randomly allocated to three groups and treated with propranolol 40 mg×4 (Group 1), 80 mg×4 (Group 2) and 160 mg×4 (Group 3). Blood pressure (BP), pulse rate (PR), plasma renin activity (PRA), plasma aldosterone concentration (PAC), total plasma propranolol (tPP), free plasma propranolol (fPP), and 24 h urinary propranolol excretion (UP) were determined at the end of four consecutive periods: (A) after four weeks without any treatment; (B) after two to three weeks during which the propranolol dose was gradually increased to the intended level; (C) after four weeks, and (D) after eight weeks of unchanged treatment. The maximum reduction in diastolic BP occurred after period B, and in systolic BP after Period C, for Groups 2 and 3, and for all groups together; for Group 1, however, the maximum diastolic BP reduction was first seen after period C. PR was reduced to the same level in all groups after period B. After period B, PRA and PAC fell in all groups, and remained reduced during C and D in Group 1. After periods C and D, PRA and PAC in Groups 2 and 3 did not differ significantly from the levels after period A; tPP, fPP and UP were significantly correlated with the propranolol dose, and were lowest in Group 1 and highest in Group 3; UP was negatively correlated with systolic but not diastolic BP in Periods B, C and D. In contrast neither fPP nor tPP were correlated with systolic or diastolic BP. There was no significant correlation between PRA, PAC and changes in PRA or PAC on the one hand and tPP, fPP, UP, BP or changes in BP on the other. It was concluded that propranolol effectively reduced BP, but diastolic BP reduction was most rapidly obtained at 320 and 640 mg daily, that the activity of the renin-aldosterone system was initially suppressed in all groups, but for unknown reasons it increased towards the control level after seven to eleven weeks of therapy with 320 and 640 mg/day, and that the reduction in systolic BP increased with higher doses of propranolol and with increasing urinary propranolol excretion.

This is a preview of subscription content, log in to check access.

References

  1. Bradley JV (1968) Distribution-free statistical tests. Prentice-Hall, Englewood Cliffs, NJ

  2. Bravo EL, Tarazi RC, Dustan HP (1975) Beta-adrenergic blockade in diuretic-treated patients with essential hypertension. N Engl J Med 292: 66–70

  3. Bühler FR, Laragh JH, Baer L, Vaughan ED, Brunner HR (1972) Propranolol inhibition of renin secretion. A specific approach to diagnosis and treatment of renin-dependent hypertensive diseases. N Engl J Med 287: 1209–1214

  4. Chidsey CA, Morselli P, Bianchetti G, Morganti A, Leonetti G, Zanchetti A (1975) Studies of the absorption and removal of propranolol in hypertensive patients during therapy. Circulation 52: 313–318

  5. Davis JO, Freeman RH (1976) Mechanisms regulating renin release. Physiol Rev 56: 1–56

  6. Geyskes GG, Boer P, Vos J, Leenen FHH, Dorhout Mess EJ (1975) Effect of salt depletion and propranolol on blood pressure and plasma renin activity in various forms of hypertension. Circ Res 36 (Suppl 1): 248–256

  7. Giese J, Jørgensen M, Nielsen MD, Lund JO, Munck O (1970) Plasma renin concentration measured by use of radioimmunoassay for angiotensin I. Scand J Clin Lab Invest 26: 355–368

  8. Hansson L (1973) Beta-adrenergic blockade in essential hypertension: Effects of propranolol on haemodynamic parameters and plasma renin activity. Acta Med Scand Suppl 550: 1–40

  9. Hollifield JW, Sherman K, Zwagg RV, Shand DG (1976) Proposed mechanisms of propranolol's antihypertensive effect in essential hypertension. N Engl J Med 295: 68–73

  10. Ibsen H, Sederberg-Olsen P (1973) Changes in glomerular filtration rate during long-term treatment with propranolol in patients with arterial hypertension. Clin Sci 44: 129–134

  11. Kraus XH, Schalekamp MADH, Kolsters G, Zaal GA, Birkenhaeger WH (1972) Effects of chronic beta-adrenergic blockade on systemic and renal haemodynamic responses to hyperosmotic saline in hypertensive patients. Clin Sci 43: 385–391

  12. Lektonen A, Kanto J, Kleimola T (1977) Plasma concentrations of propranolol in patients with essential hypertension. Eur J Clin Pharmacol 11: 155–157

  13. Lewis P (1976) The essential action of propranolol in hypertension. Am J Med 60: 837–852

  14. Lorimer AR, Dunn FG, Jones JV, Lawrie TDV (1976) Beta-adrenoreceptor blockade in hypertension. Am J Med 60: 877–885

  15. Mookherjee S, Eich RH, Obeid AI, Smulyan H (1977) Haemodynamic and plasma renin effects of propranolol in essential hypertension. Arch Intern Med 137: 290–295

  16. Nielsen I, Steiness E, Hesse B (1976) Plasma renin activity and blood pressure during long-term treatment with propranolol and diuretic. Acta Med Scand Suppl 602: 97–101

  17. Pedersen EB (1978) Abnormal renal haemodynamics during exercise in young patients with mild essential hypertension without treatment and during long-term propranolol therapy. Scand J Clin Lab Invest 38: 567–571

  18. Pedersen EB (1979) Some aspects of kidney function, the reninaldosterone system and sympathetic activity in essential hypertension. Acta Med Scand Suppl 636: 1–66

  19. Pedersen EB, Christensen NJ (1975) Catecholamines in plasma and urine in patients with essential hypertension determined by double-isotope derivative techniques. Acta Med Scand 198: 373–377

  20. Pedersen EB, Kornerup HJ (1976) Relationship between plasma aldosterone concentration and plasma potassium in patients with essential hypertension during alprenolol treatment. Acta Med Scand 200: 263–267

  21. Pedersen EB, Kornerup HJ (1977) Plasma renin concentration in essential hypertension during beta-adrenergic blockade and vasodilator therapy. Eur J Clin Pharmacol 12: 93–96

  22. Pedersen G, Pedersen A, Pedersen EB (1979) Effect of propranolol on total exchangeable body potassium and sodium in essential hypertension. Scand J Clin Invest 39: 167–170

  23. Rask-Madsen J, Bruusgaard A, Munck O, Nielsen MD, Worming H (1974) The significance of bile acids and aldosterone for the electrical hyperpolarization of human rectum in obese patients treated with intestinal by-pass operation. Scand J Gastroenterol 9: 417–426

  24. Verniory A, Staroukine M, Delwiche F, Telarman M (1976) Effect of sotalol on haemodynamics and renin-angiotensinaldosterone system in hypertensive patients. Clin Sci Mol Med 51: 9–17

  25. Waal-Manning H (1976) Metabolic effects of beta-adrenoreceptor blockers. Drugs 11 Suppl 1: 121–126

  26. Walle T (1974) GLC determination of propranolol, other beta-adrenergic, and metabolites in biological fluids and tissues. J Pharm Sci 63: 1885–1891

  27. Walle T, Conradi EC, Walle UK, Fagan TC, Gaffney TE (1978) The predictable relationship between plasma levels and dose during chronic propranolol therapy. Clin Pharmacol Ther 24: 668–677

  28. Weder HG, Schildknecht J, Kesselring P (1971) A new equilibrium dialyzing system. Am Lab 10: 15–21

  29. Wong L, Nation RL, Chiou WL, Mehta PK (1979) Plasma concentrations of propranolol and 4-hydroxypropranolol during chronic oral propranolol therapy. Br J Clin Pharmacol 8: 163–167

  30. Woods JW, Pittman AW, Pulliam CC, Werk EE Jr, Waider W, Allen CA (1976) Renin profiling in hypertension and its use in treatment with propranolol and chlorthalidone. N Engl J Med 294: 1137–1143

  31. Zacest R, Koch-Weser J (1972) Relation of propranolol plasma level to beta-blockade during oral therapy. Pharmacology 7: 178–184

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Pedersen, E.B., Kornerup, H.J., Pedersen, O.L. et al. Correlation between propranolol in plasma and urine, renin-aldosterone system and blood pressure in essential hypertension. Eur J Clin Pharmacol 20, 251–258 (1981). https://doi.org/10.1007/BF00618774

Download citation

Key words

  • aldosterone
  • hypertension
  • propranolol
  • blood pressure
  • plasma level
  • renin
  • urine level