[Acute Combined Alpha- and Beta-adrenergic Blockade in Essential Hypertension: Effects on Blood Pressure, Renal Function, Renin, and Aldosterone]

Overview

Journal Klin Wochenschr

Specialty General Medicine

Date 1979 Jul 15

PMID 470335

Authors

U GRUNINGER

R Akert

H Hunkeler

E Wegmuller

P Weidmann

J Hodler

Affiliations

Soon will be listed here.

Abstract

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 X 14 days) (- 14.5% verus - 7.4% for pulse pressure, - 12.4% versus - 6.0% for diastolic pressure, 2 alpha less than 0.05). Under combined adrenergic blockade renal plasma flow increased, glomerular filtration rate and filtration fraction decreased (2 alpha less than 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-angiotensin-axis.

References

Zambraski E, Dibona G, Kaloyanides G . Effect of sympathetic blocking agents on the antinatriuresis of reflex renal nerve stimulation. J Pharmacol Exp Ther. 1976; 198(2):464-72. View

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

GILL Jr J, CASPER A . Effect of renal alpha-adrenergic stimulation on proximal tubular sodium reabsorption. Am J Physiol. 1972; 223(5):1201-5. DOI: 10.1152/ajplegacy.1972.223.5.1201. View

Dibona G, Zambraski E, Aguilera A, Kaloyanides G . Neurogenic control of renal tubular sodium reabsorption in the dog: a brief review and preliminary report concerning possible humoral mediation. Circ Res. 1977; 40(5 Suppl 1):I127-30. View

Gould L, Reddy C . Phentolamine. Am Heart J. 1976; 92(3):397-402. DOI: 10.1016/s0002-8703(76)80121-4. View

Weidmann P, de Chatel R, ZIEGLER W, Flammer J, REUBI F . Alpha and beta adrenergic blockade with orally administered labetalol in hypertension. Studies on blood volume, plasma renin and aldosterone and catecholamine excretion. Am J Cardiol. 1978; 41(3):570-6. DOI: 10.1016/0002-9149(78)90017-6. View

MICHELAKIS A, McALLISTER R . The effect of chronic adrenergic receptor blockade on plasma renin activity in man. J Clin Endocrinol Metab. 1972; 34(2):386-94. DOI: 10.1210/jcem-34-2-386. View

Prichard B, GILLAM P . Treatment of hypertension with propranolol. Br Med J. 1969; 1(5635):7-16. PMC: 1981816. DOI: 10.1136/bmj.1.5635.7. View

Weidmann P, Maxwell M, de LIMA J, Hirsch D, Franklin S . Control of aldosterone responsiveness in terminal renal failure. Kidney Int. 1975; 7(5):351-7. DOI: 10.1038/ki.1975.48. View

10.

Kelly D, Delgado C, Taylor D, Pitt B, Ross R . Use of phentolamine in acute myocardial infarction associated with hypertension and left ventricular failure. Circulation. 1973; 47(4):729-35. DOI: 10.1161/01.cir.47.4.729. View

11.

Vorburger C, Riedwyl H, REUBI F . [Comparative studies on the renal clearance of Na-Cr2Cr51 ethylenediaminetetraacetate, inulin and sodium thiosulfate in humans]. Klin Wochenschr. 1969; 47(8):415-20. DOI: 10.1007/BF01745785. View

12.

Capponi A, Vallotton M . 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. 1976; 39(2):200-3. DOI: 10.1161/01.res.39.2.200. View

13.

Johnson B, LaBrooy J, MUNRO-FAURE A . Comparative anti-hypertensive effects of labetalol and the combination of oxprenolol and phentolamine. Br J Clin Pharmacol. 1976; 3(4 Suppl 3):783-7. View

14.

Dollery C . Closing remarks: current status of labetalol. Br J Clin Pharmacol. 1976; 3(4 Suppl 3):823-4. View

15.

Miller H, Alexander J . Use of phentolamine (Regitine) to prevent and dissipate vasospasm in donor kidneys. Surg Forum. 1972; 23(0):273-5. View

16.

MEURER K, Krause D, Kaufmann W . [Influence of adrenergic drugs on renal hemodynamics and excretory function]. Verh Dtsch Ges Inn Med. 1973; 79:797-800. View

17.

VANDONGEN R, Peart W . The inhibition of renin secretion by alpha-adrenergic stimulation in the isolated rat kidney. Clin Sci Mol Med. 1974; 47(5):471-9. DOI: 10.1042/cs0470471. View

18.

Vetter W, Vetter H, Siegenthaler W . Radioimmunoassay for aldosterone without chromatography. 2. Determination of plasma aldosterone. Acta Endocrinol (Copenh). 1973; 74(3):558-67. DOI: 10.1530/acta.0.0740558. View

19.

Beilin L, Juel-Jensen B . Alpha and beta adrenergic blockade in hypertension. Lancet. 1972; 1(7758):979-82. DOI: 10.1016/s0140-6736(72)91154-3. View

20.

DiSalvo J, Fell C . Drug-evoked neural responses in the canine renal vascular bed. Am J Physiol. 1971; 220(6):1586-92. DOI: 10.1152/ajplegacy.1971.220.6.1586. View