Skip to main content
SpringerLink
Log in

Akute kombinierte Alpha- und Betarezeptorenblockade bei essentieller Hypertonie: Wirkungen auf Blutdruck, Nierenfunktion, Renin und Aldosteron

Acute combined alpha- and beta-adrenergic blockade in essential hypertension: Effects on blood pressure, renal function, renin, and aldosterone

  • Originalien
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

In seven patients with uncomplicated essential hypertension the effects of an acute alpha-adrenergic blockade, alone and combined with a chronic beta-adrenergic blockade, on blood pressure, renal function as measured by standard clearance methods, plasma renin activity, and plasma aldosterone were evaluated.

Acute alpha-adrenergic blockade with phentolamine (20 mg by intravenous infusion) significantly enhanced the antihypertensive effect of chronic beta-adrenergic blockade with slow-oxprenolol (160 mg/day×14 days) (−14.5% versus −7.4% for pulse pressure, −12.4% versus −6.0% for diastolic pressure, 2α<0.05). Under combined adrenergic blockade renal plasma flow increased, glomerular filtration rate and filtration fraction decreased (2α<0.05 each), whereas the fractional clearances of sodium, potassium, free water, and solute load remained unchanged. The activation of the renin-angiotensin-axis, elicited by alpha-adrenergic blockade alone, was suppressed by the preceding beta-adrenergic blockade.

These findings demonstrate a favourable antihypertensive action of a combined blockade of alpha-und beta-adrenergic receptor sites without untoward side effects on renal function or the renin-angiotensinaxis.

Zusammenfassung

Bei sieben Patienten mit unkomplizierter essentieller Hypertonie wurden unter Dauerinfusionsclearance-Bedingungen die Wirkungen einer akuten Blockade der Alpharezeptoren, allein oder in Kombination mit einer chronischen Betarezeptorenblockade, auf Blutdruck, Nierenfunktion, Plasmarenin und Aldosteron untersucht.

Akute Alphablockade mit Phentolamin (20 mg intravenös infundiert) verstärkte den blutdrucksenkenden Effekt einer chronischen Betablockade mit Slow-Oxprenolol (160 mg/Tag × 14 Tage) signifikant (−14,5% gegenüber −7,4% systolisch, −12,4% gegenüber −6% diastolisch, 2α jeweils <0,05). Unter der kombinierten Rezeptorenblockade nahmen der renale Plasmafluß zu, die glomeruläre Filtration und die Filtrationsfraktion ab (jeweils 2α<0,05), während die fraktionellen renalen Clearances von Natrium, Kalium, freiem Wasser und “solute load” unverändert blieben. Die Aktivierung der Renin-Angiotensin-Achse, die unter alleiniger Alpharezeptorenblockade auftrat, wurde durch vorausgehende Betarezeptorenblockade verhindert.

Diese Befunde zeigen einen günstigen blutdrucksenkenden Effekt einer akuten kombinierten Alphaund Betarezeptorenblockade, ohne unerwünschte Auswirkungen auf Nierenfunktion und Renin-Angiotensin-Achse.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Beilin, L.J., Juel-Jensen, B.E.: Alpha and beta adrenergic blokkade in hypertension. LancetI, 979 (1972)

    Google Scholar 

  2. Besarab, A., Silva, P., Landsberg, L., Epstein, F.H.: Effect of catecholamines on tubular function in the isolated perfused rat kidney. Am. J. Physiol.233, F39-F45 (1977)

    Google Scholar 

  3. Bonjour, J.P., Malvin, R.L.: Stimulation of ADH release by the renin-angiotensin system. Am. J. Physiol.218, 1555–1559 (1970)

    Google Scholar 

  4. Capponi, A.M., Vallotton, M.B.: Renin release by rat kidney slices incubated in vitro: Role of sodium and of alpha and beta adrenergic receptors, and effect of vincristine. Circ. Res.39, 200–203 (1976)

    Google Scholar 

  5. Coote, J.H., Johns, E.J., MacLeod, V.H., Singer, B.: Effect of renal nerve stimulation, renal blood flow and adrenergic blockade on plasma renin activity in the cat. J. Physiol. (Lond.)226, 15–36 (1972)

    Google Scholar 

  6. De Châtel, R., Weidmann, P., Flammer, J., Ziegler, W.H., Beretta-Piccoli, C., Vetter, W., Reubi, F.C.: Sodium, renin, aldosterone, catecholamines, and blood pressure in diabetes mellitus. Kidney Int.12, 412–421 (1977)

    Google Scholar 

  7. Di Bona, G.F., Zambraski, E.J., Aguilera, A.J., Kaloyanides, G.J.: Neurogenic control of renal tubular sodium reabsorption in the dog. Circ. Res. (Suppl. I)40, I-127–I-130 (1977)

    Google Scholar 

  8. Di Salvo, J., Fell, C.: Drug-evoked neural responses in the canine renal vascular bed. Am. J. Physiol.220, 1586–1592 (1971)

    Google Scholar 

  9. Dollery, C.T.: Closing remarks: Current status of labetalol. Br. J. Clin. Pharmacol. (Suppl. 3)3, 823–824 (1976)

    Google Scholar 

  10. Gill, J.R., Casper, A.G.T.: Depression of proximal tubular sodium reabsorption in the dog in response to renal beta-adrenergic stimulation by isoproterenol. J. Clin. Invest.50, 112–118 (1971)

    Google Scholar 

  11. Gill, J.R., Casper, A.G.T.: Effect of renal alpha-adrenergic stimulation on proximal tubular sodium reabsorption. Am. J. Physiol.223, 1201–1205 (1973)

    Google Scholar 

  12. Gould, L., Reddy, C.V.R.: Phentolamine. Am. Heart J.92, 397–402 (1976)

    Google Scholar 

  13. Hallauer, W., Schirmeister, J., Hartig, G.: Glomeruläre Filtration und renale Natriumbearbeitung unter Furosemid vor und nach Alpharezeptorenblockade durch Phentolamin. Therapiewoche24, 629–634 (1974)

    Google Scholar 

  14. Hodler, J.: Metabolische Wirkungen der Betablocker. Therapiewoche25, 10–15 (1975)

    Google Scholar 

  15. Hollenberg, N.K., Adams, D.F.: The renal circulation in hypertensive disease. Am. J. Med.60, 773–784 (1976)

    Google Scholar 

  16. Johnson, B.F., La Brooy, J., Munro-Faure, A.D.: Comparative antihypertensive effects of labetalol and the combination of oxprenolol and phentolamine. Br. J. Clin. Pharmacol. (Suppl. 3)3, 783–787 (1976)

    Google Scholar 

  17. Kelly, D.T., Delgado, C.E., Taylor, D.R., Pitt, B., Ross, R.S.: Use of phentolamine in acute myocardial infarction associated with hypertension and left ventricular failure. Circulation47, 729–735 (1973)

    Google Scholar 

  18. Lancet/Editorial: A new approach to the treatment of hypertension. Lancet2, 85 (1970)

    Google Scholar 

  19. Leenen, F.H.H., Redmond, D.P., McDonald, H.: Alpha and beta adrenergic-induced renin release in man. Clin. Pharmacol. Ther.18, 31–38 (1975)

    Google Scholar 

  20. Majid, P.A., Sharma, B., Meeran, M.K., Taylor, S.H.: Combined alpha and beta adrenergic blockade in treatment of hypertension. Br. Heart J.35, 5, 561 (1973)

    Google Scholar 

  21. Majid, P.A., Meeran, M.K., Benaim, M.E., Sharma, B., Taylor, S.H.: Alpha- and beta-adrenergic receptor blockade in the treatment of hypertension. Br. Heart J.36, 588–596 (1974)

    Google Scholar 

  22. Meurer, K.A., Krause, D.K., Kaufmann, W.: Der Einfluß adrenerger Pharmaka auf die renale Hämodynamik und Ausscheidungsfunktion. In: Verhandlungen der Deutschen Gesellschaft für Innere Medizin, 79. Kongreß in Wiesbaden 1973. Schlegel, B. (ed.), S. 797–800. München: Bergmann 1973

    Google Scholar 

  23. Michelakis, A.M., McAllister, R.G., Jr.: The effect of chronic adrenergic receptor blockade on plasma renin activity in man. J. Clin. Endocrinol. Metab.34, 386–394 (1972)

    Google Scholar 

  24. Miller, H.C., Alexander, J.W.: Use of phentolamine (regitine) to prevent and dissipate vasospasm in donor kidneys. Surg. Forum23, 273–275 (1972)

    Google Scholar 

  25. Pettinger, W.A., Keeton, T.K., Campbell, W.B., Harper, D.C.: Evidence for a renal alpha-adrenergic receptor inhibiting renin release. Circ. Res.38, 338–346 (1976)

    Google Scholar 

  26. Prichard, B.N.C., Gilliam, P.M.S.: Treatment of hypertension with propranolol. Br. Med. J.1, 7–16 (1969)

    Google Scholar 

  27. Reubi, F.C.: Nierenkrankheiten. 2. Aufl. Bern: Huber 1970

    Google Scholar 

  28. Reubi, F.C.: Role of physical factors in the acute changes in renal function elicited by antihypertensive drugs. Eur. J. Clin. Pharmacol.13, 1–9 (1978)

    Google Scholar 

  29. Sealey, J.E.: The renin system: variations in man measured by radioimmunoassay or bioassay. Kidney Int.1, 240–253 (1972)

    Google Scholar 

  30. Schrier, R., Berl, T., Harbottle, J.A., McDonald, K.M.: Catecholamines and renal water excretion. Nephron15, 186–196 (1975)

    Google Scholar 

  31. Trust, P.M., Rosei, E.A., Brown, J.J., Fraser, R., Lever, A.F., Morton, J.J., Robertson, J.I.S.: Effect of blood pressure, angiotensin II and aldosterone concentrations during treatment of severe hypertension with intravenous labetalol: Comparison with propranolol. Br. J. Clin. Pharmacol. (Suppl. 3)3, 799–803 (1976)

    Google Scholar 

  32. Vandongen, R., Peart, W.S.: The inhibition of renin secretion by alpha adrenergic stimulation in the isolated rat kidney. Clin. Sci. Mol. Med.47, 471–479 (1974)

    Google Scholar 

  33. Vetter, W., Vetter, H., Siegenthaler, W.: Radioimmunoassay for aldosterone without chromatography. II. Determination of plasma aldosterone. Acta Endocrinol. (Kbh.)74, 558–567 (1973)

    Google Scholar 

  34. Vorburger, C., Riedwyl, H., Reubi, F.C.: Vergleichende Studien zwischen den renalen Clearances von51Cr-EDTA, Insulin und Natriumthiosulfat beim Menschen. Klin. Wochenschr.47, 415–420 (1969)

    Google Scholar 

  35. Weber, T.R., Freier, D.T., Salles, C.A., Ramsburgh, S.R., Lindenauer, S.M.: Effect of phenolamine on perfusate flow characteristics during renal preservation. J. Surg. Res.21, 21–25 (1976)

    Google Scholar 

  36. Weidmann, P., Maxwell, M.H., DeLima, J., Hirsch, D., Franklin, S.S.: Control of aldosterone responsiveness in terminal renal failure. Kidney Int.7, 351–359 (1975)

    Google Scholar 

  37. Weidmann, P., de Châtel, R., Schiffmann, A., Bachmann, E., Beretta-Piccoli, C., Reubi, F.C., Vetter, W.: Interrelations between age and plasma renin, aldosterone and cortisol, urinary catecholamines and the body sodium/volume state in normal man. Klin. Wochenschr.55, 725–733 (1977)

    Google Scholar 

  38. Weidmann, P., de Châtel, R., Ziegler, W.H., Flammer, J., Reubi, F.C.: Alpha and beta adrenergic blockade with orally administered labetalol in hypertension. Am. J. Cardiol.43, 570–576 (1978)

    Google Scholar 

  39. Weidmann, P.: Die Bedeutung des Renin-Angiotensin-Aldosteron-Systems bei der Hypertonie. Pädiatr. Fortbildungskurse Prax.45, 97–119 (1978)

    Google Scholar 

  40. Winer, N., Chokshi, D.S., Yoon, M.S., Freedman, A.D.: Adrenergic receptor mediation of renin secretion. J. Clin. Endocrinol.29, 1169 (1969)

    Google Scholar 

  41. Zambraski, E.J., Di Bona, G.F., Kaloyanides, G.J.: Effect of sympathetic blocking agents on the antinatriuresis of reflex renal nerve stimulation. J. Pharmacol. Exp. Ther.198, 464–472 (1976)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Klinische Pathologie und Medizinische Poliklinik der Universität Bern, Germany

    U. Grüninger, R. Akert, H. Hunkeler, E. Wegmüller, P. Weidmann &  J. Hodler

Authors
  1. U. Grüninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Akert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Hunkeler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Wegmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Weidmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Hodler
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grüninger, U., Akert, R., Hunkeler, H. et al. Akute kombinierte Alpha- und Betarezeptorenblockade bei essentieller Hypertonie: Wirkungen auf Blutdruck, Nierenfunktion, Renin und Aldosteron. Klin Wochenschr 57, 731–739 (1979). https://doi.org/10.1007/BF01477555

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01477555

Key words

Schlüsselwörter

Search

Navigation