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β-Adrenergic Receptor Blocking Drugs in Hypertension

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Summary

The β-adrenergic receptor blocking drugs (β-blockers) are proving to be extremely useful in antihypertensive therapy. The reasons for their antihypertensive effect are not entirely clear, but a reduction in cardiac output and in renin release by the kidney seem to be the most probable explanations.

The β-blockers can be used alone to control hypertension, especially in mild cases, but combined treatment with a diuretic is more effective and probably less liable to cause dyspnoea. The use of β-blockers along with adrenergic neurone-blocking drugs (and usually with a diuretic also) is often successful. Combined therapy with a diuretic and a peripheral vasodilator appears to be promising. In general, blood pressure control in many patients is improved by the addition of a β-blocker to their existing regimen.

Much of the reported work has been done with propranolol which differs from most of the other β-blockers in common use in having no intrinsic sympathomimetic effect (partial agonist activity). If necessary, the dosage of propranolol can be raised to a high level to achieve results in resistant cases. However, it seems likely that there is more of a ceiling to the antihypertensive effect of the other β-blocking drugs, though the evidence on this point is by no means definite.

β-blockers must never be used without due consideration of the patient’s cardiac status or without enquiry concerning a history of broncho spasm or other chronic chest disease. If these precautions are taken, and if diuretics and perhaps digitalis are used in patients with possible cardiac decompensation, the incidence of two serious side-effects (cardiac failure and asthma) is very low. A cardioselective drug (e.g. practolol) should be chosen for patients possibly at risk of asthma, but some danger of precipitating bronchospasm remains even with practolol.

While many hypertensive patients may benefit from the use of β-blockers, those with tachycardia or labile hypertension may respond especially well, and perhaps also those with high plasma renin. Patients with angina, cardiac arrhythmias, dissecting aneurysm, or cerebral aneurysm usually receive extra benefit from 0-blockade. New cases of hypertension of some severity are best treated initially with drugs other than β-blockers as achievement of blood pressure control with β-blockers may take some time.

The high dosage and long-continued administration of β-blockers used in the treatment of hypertension necessitates that a watch be kept for side-effects. Apart from cardiac failure and asthma (the incidence of which should be very low), mental depression, vivid dreams or nightmares can occur, and Raynaud’s phenomenon can be troublesome. Minor gastroenterological symptoms are not uncommon. Occasional instances of autoimmune phenomena have been reported with practolol.

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Simpson, F.O. β-Adrenergic Receptor Blocking Drugs in Hypertension. Drugs 7, 85–105 (1974). https://doi.org/10.2165/00003495-197407010-00006

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