Cardioselectivity of atenolol in asthmatic patients

Abstract

This double-blind, randomised, within patient, placebo-controlled study set out to investigate the effect of a cardioselective beta-blocker, atenolol, at different oral doses (50, 100 and 200 mg) and a non-selective agent, propranolol (40 mg), upon 1. airways resistance (forced expiratory volume at one second = FEV1) and 2. the bronchodilator action of increasing doses of inhaled isoprenaline, in patients with co-existent hypertension and reversible airways obstruction. In 10 patients, two hours after drug administration, the 3 doses of atenolol caused a significantly greater (P less than 0.05) degree of B1-blockade than propranolol. In contrast the 3 doses of atenolol caused significantly less (P less than 0.05 to 0.01) B2-blockade as evidenced by a smaller fall in FEV1. The isoprenaline FEV1 dose response curves were displaced progressively to the right of the placebo curve with increasing doses of atenolol, but the greatest displacement was with propranolol. It was concluded that patients with reversible airways obstruction who require beta-blockade should be given a low dose of a cardioselective agent in conjunction with, if required, a beta 2 stimulant such as isoprenaline. Such a treatment will be less likely to cause a troublesome increase in airways resistance and the bronchodilator action of the beta 2 stimulant will be almost fully preserved.

Effects of ICI 141,292 on exercise tachycardia and isoprenaline‐induced beta‐adrenoceptor responses in man.

“…The exact mechanism of the rise in systolic blood pressure during isoprenaline infusion is uncertain but a positive sympathetic baroceptor reflex initiated by a fall in diastolic blood pressure after [2-adrenoceptor stimulation has been suggested (Arnold & McDevitt, 1984 (Lertora et al, 1975), metoprolol (Formgren, 1976) and atenolol (Ellis et al, 1981). Our findings suggest that the cardioselectivity of ICI 141,292 is dose dependent which is in agreement with the findings of previous investigators (Norris et al, 1984).…”

Pharmacological modulation of β-adrenoceptor function in patients with coexisting chronic obstructive pulmonary disease and chronic heart failure

“…whether a β-blocker is β 1 -AR selective or β 1 -AR nonselective [67][68][69][70][71][72]. β 1 -blockade does not attenuate β 2 -agonist induced bronchodilation.…”

Lack of effect of atenolol on the pharmacokinetics of theophylline.

“…Although P-adrenoceptor blockade is not the treatment of choice in these situations, atenolol, a cardioselective 3-adrenoceptor blocker may be used as daily doses below 100 mg have little effect on airway resistance (Decalmer et al, 1978;Ellis et al, 1981;Lawrence et al, 1983 On each study day, theophylline was administered intravenously as aminophylline (ElkinsSinn, Inc., Cherry Hill, New Jersey; Lot #: 066074 containing 79.36% theophylline). Approximately a 6 mg kg-' (ideal body weight) dose was infused over 30 min.…”