Skip to main content

β-Adrenergic Blocker Treatment of Hypertension

Pharmacodynamics and Guide to Patient Selection

  • Chapter
Hypertension Medicine

Part of the book series: Current Clinical Practice ((CCP))

  • 156 Accesses

Abstract

β-Adrenergic receptor blockade is a principal treatment for cardiovascular disease, including ischemic heart disease and heart failure (1,2). Hypertension is a leading risk factor for these major causes of death in modern society. Although β-blockers lower blood pressure (BP) in many patients (3,4), their antihypertensive efficacy varies widely among individuals, indicating the pathophysiologic heterogeneity of hypertension (5,6). In fact, of all the hypertensive patients in the United States who are treated with an antihypertensive medication, fewer than half achieve a target pressure of ≤140/90 mmHg (7). This chapter reviews some of the mechanisms by which β-blockers lower BP and provides a rational approach for identifying the hypertensive patient who is most likely to have a favorable response to this treatment.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Gottlieb SS, McCarter RJ, Vogel RA (1998) Effect of beta-blockade on mortality among high-risk and low risk patients after myocardial infarction. N Engl J Med 339: 489–497.

    Article  PubMed  CAS  Google Scholar 

  2. Packer M, Bristow MR, Cohn JN, et al. (1996) The effect of Carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 334: 1349–1355.

    Article  PubMed  CAS  Google Scholar 

  3. Kannel WB (1996) Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 275: 1571–1576.

    Article  PubMed  CAS  Google Scholar 

  4. Prichard BNC, Cruickshank JM (1995) Beta-blockade in hypertension: past, present, and future. In: Laragh JH, Brenner BM, eds. Hypertension: Pathophysiology, Diagnosis, and Management, vol. 2, New York: Raven, pp. 2827–2859.

    Google Scholar 

  5. Preston RA, Materson BJ, Reda DJ, et al. (1998) Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. JAMA 280: 1168–1172.

    Article  PubMed  CAS  Google Scholar 

  6. Blumenfeld JD, Laragh JH (1998) Renin system analysis: a rational method for the diagnosis and treatment of the individual patient with hypertension. Am J Hypertens 11: 894–896.

    Article  PubMed  CAS  Google Scholar 

  7. Burt VL, Whelton P, Roccella EJ, et al. (1995) Prevalence of hypertension in the U.S. population: results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 25: 305–314.

    Article  PubMed  CAS  Google Scholar 

  8. McDevitt DG (1981) Differential features of beta-adrenoceptor blocking drugs for therapy. In: Laragh JH, Buhler FR, eds. Selding, D.W., vol. 1, Frontiers in Hypertension Research, New York: Springer-Verlag, pp. 473–481.

    Google Scholar 

  9. Buhler FR. Antihypertensive actions of beta-blockers. In: Laragh JH, Buhler FR, Seldin DW, eds. Frontiers in Hypertension Research, vol. 1, New York: Springer-Verlag, pp. 424–435.

    Google Scholar 

  10. Blumenfeld JD, Vaughan ED Jr (1999) Hypertensive adrenal disorders. In: Brady HR, Wilcox CS, eds. Therapy in Nephrology and Hypertension, vol. 1, Philadelphia: W. B. Saunders, pp. 451–462.

    Google Scholar 

  11. Buhler FR, Laragh JH, Baer L, Vaughan ED Jr, 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.

    Article  PubMed  CAS  Google Scholar 

  12. Buhler FR, Laragh JH, Vaughan ED Jr, Brunner HR, Gavras H, Baer L (1973) Antihypertensive action of propranolol: specific antirenin responses in high and normal renin forms of essential, renal, renovascular and malignant hypertension. Am J Cardiol 32: 511–522.

    Article  PubMed  CAS  Google Scholar 

  13. Laragh JH, Sealey JE (1992) Renin-angiotensin-aldosterone system and the renal regulation of sodium, potassium, and blood pressure homeostasis. In: Windhager EE, ed. Handbook of Physiology, Renal Physiology, vol. 2, New York: Oxford University Press, pp. 1409–1541.

    Google Scholar 

  14. Goodfriend TL, Elliott ME, Catt KJ (1996) Angiotensin receptors and their antagonists. N Engl J Med 334: 1649–1654.

    Article  PubMed  CAS  Google Scholar 

  15. Sealey JE, Blumenfeld JD, Bell GM, Pecker MS, Sommers SC, Laragh JH (1988) On the renal basis for essential hypertension: nephron heterogeneity with discordant renin secretion and sodium excretion causing a hypertensive vasoconstriction-volume relationship. J Hypertens 6: 763–777.

    Article  PubMed  CAS  Google Scholar 

  16. Brunner HR, Laragh JH, Baer L, et al. (1972) Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 286: 441–449.

    Article  PubMed  CAS  Google Scholar 

  17. Laragh JH (1995) Renin system understanding for analysis and treatment of hypertensive patients: a means to quantify the vasoconstrictor elements, diagnose curable renal and adrenal causes, assess risk of cardiovascular morbidity, and find the best fit drug regimen. In: Laragh JH, Brenner BM, eds. Hypertension: Pathophysiology, Diagnosis, and Management, vol. 2, New York: Raven, pp. 1813–1836.

    Google Scholar 

  18. Campbell WG Jr, Gahnem F, Catanzaro DF, et al. (1996) Plasma and renal prorenin/renin, renin mRNA, and blood pressure in Dahl salt-sensitive and salt-resistant rats. Hypertension 27: 1121–1133.

    Article  PubMed  CAS  Google Scholar 

  19. Atlas SA, Sealey JE, Laragh JH, Moon C (1977) Plasma renin and “prorenin” in essential hypertension during sodium depletion, beta-blockade, and reduced arterial pressure. Lancet 2: 785–789.

    Article  PubMed  CAS  Google Scholar 

  20. Blumenfeld JD, Sealey JE, Mann SA, et al. (1999) Beta-adrenergic receptor blockade as a therapeutic approach for suppressing the renin-angiotensin-aldosterone system in normotensive and hypertensive subjects. Am J Hypertens 12: 451–459.

    Article  PubMed  CAS  Google Scholar 

  21. Bragat AC, Blumenfeld J, Sealey JE (1997) Effect of high-performance liquid chromatography on plasma angiotensin II measurements in treated and untreated normotensive and hypertensive patients. J Hypertens 15: 459–465.

    PubMed  CAS  Google Scholar 

  22. Pickering TG, Case DB, Sullivan PA, Laragh JH (1982) Comparison of antihypertensive and hormonal effects of captopril and propranolol at rest and during exercise. Am J Cardiol 49: 1566–1588.

    Article  PubMed  CAS  Google Scholar 

  23. Messerli FH, Grossman E, Goldbourt U (1998) Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 279: 1903–1907.

    Article  PubMed  CAS  Google Scholar 

  24. McAlpine HM, Mortin JJ, Leckie B, Rumley A, Gillen G, Dargie HJ (1988) Neuroendocrine activation after acute myocardial infarction. Br Heart J 60: 117–124.

    Article  PubMed  CAS  Google Scholar 

  25. Gavras H, Brown JJ, Lever AF, et al. (1971) Acute renal failure, tubular necrosis, and myocardial infarction induced in the rabbit by intravenous angiotensin II. Lancet 2: 19–22.

    Article  PubMed  CAS  Google Scholar 

  26. Alderman MH, Madhavan S, Ooi WL, Cohen H, Sealey JE, Laragh JH (1991) Association of the renin-sodium profile with the risk of myocardial infarction in patients with hypertension. N Engl J Med 324: 1098–1104.

    Article  PubMed  CAS  Google Scholar 

  27. ACE Inhibitor Myocardial Infarction Collaborative Group (1998) Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of the individual data from 100,000 patients in randomized trials. Circulation 97: 2202–2212.

    Google Scholar 

  28. Blumenfeld JD, Sealey JE, Alderman MH, Cohen H, Lappin R, Laragh JH Association between plasma renin activity and acute myocardial infarction in normotensive and hypertensive patients. Am J Hypertens,to be published.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2001 Springer Science+Business Media New York

About this chapter

Cite this chapter

Blumenfeld, J.D. (2001). β-Adrenergic Blocker Treatment of Hypertension. In: Weber, M.A. (eds) Hypertension Medicine. Current Clinical Practice. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-008-7_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-008-7_26

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4757-5446-9

  • Online ISBN: 978-1-59259-008-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics