Hemodynamic and vascular responses to antihypertensive treatment with adrenergic blocking agents: A review

Sannerstedt, Rune; Conway, James

doi:10.1016/0002-8703(70)90402-3

Cited by 59 publications

(15 citation statements)

References 36 publications

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“…In both groups supine and standing pressures were comparable in the control state (days 1-7), without significant fluctuations during the day. In group 1 the single value derived from the average of all daily determinations was 210/126 mm Hg on day 7 potentiation of the hypotensive response, in reduction of the pressure fluctuations during the day, and in restraint of heart rate reaction to nifedipine. These effects became progressively more evident from days 18-20 and stabilized in the subsequent days.…”

Section: Resultsmentioning

confidence: 97%

Short- and long-term efficacy of a calcium-antagonistic agent (nifedipine) combined with methyldopa in the treatment of severe hypertension.

Fiorentini²,

et al. 1980

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Nifedipine induces a potent vasodilating and antihypertensive effect in man through a calciumantagonistic action. The drug was tested alone and in combination with methyidopa in 23 subjects with uncomplicated primary severe hypertension (diastolic pressure > 120 mm Hg) in a short-and long-term therapeutic trial. Hourly pressure readings during the short-term period showed that the antihypertensive response to nifedipine (10 mg orally) is maximal within 40 minutes and lasts for 8-12 hours. When nifedipine is administered every 6 hours the tendency of blood pressure to rise after each dose is repressed by the next dose, so that pressure remains significantly reduced throughout the 24 hours; when methyidopa is combined (250 mg four times daily) blood pressure is further reduced toward normal, without significant fluctuations during the day. After 10 days of drug combination, the antihypertensive response was mediated through reduction of peripheral vascular resistance associated with increase in cardiac output. Renal function was unchanged or improved and sodium retention and plasma volume expansion were not promoted. In six patients with very severe hypertension (diastolic pressure > 140 mm Hg) complicated by cardiac failure, a dosing regimen every 4 hours of the two compounds promptly relieved dyspnea and lung congestion and, within 2-3 days, stabilized blood pressure to an average of 150/98 mm Hg. Persistence of the antihypertensive efficacy of this drug combination in a dosing regimen every 6 hours and its beneficial effects on heart size, ECG and fundi were documented in 22 subjects (four of whom belonged to the decompensated group) who completed a 12-month follow-up. A tendency in seven cases to ankle pitting or edema was the major side effect of nifedipine; the cause of this effect remains obscure. NIFEDIPINE specifically inhibits the penetration of extracellular calcium through the cell membrane and the inflow of Ca++ ions from the binding sites of the sarcoplasmic reticulum into the cell plasma where ATPase of the myofibrils is located. This effect prevents splitting of ATP for the energy-delivering process of smooth-muscle contraction. One of the consequences in man of this pharmacologic property is systemic vasodilatation, which generally induces profound blood pressure fall when pressure is excessively elevated. On this basis, several investigators have explored the use of nifedipine in the acute and chronic management of hypertension.'-' A short-term therapeutic trial carried out by our group3 showed that in primary hypertensive subjects the hypotensive response to a 10-mg oral dose is maximal within less than 1 hour and proportional to the baseline level of systemic vascular resistance; after maximal fall, pressure tends to recover and approaches the control levels in the subsequent 8-12 hours; a dosing regimen every 6 hours significantly reduces blood pressure over the 24 hours, although some fluctuation occurs owing to the rate of decay of the vasodilating effect; the hemodynamics of the pressure fal...

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Section: Resultsmentioning

confidence: 97%

Short- and long-term efficacy of a calcium-antagonistic agent (nifedipine) combined with methyldopa in the treatment of severe hypertension.

Fiorentini²,

et al. 1980

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“…The reduction renal function was first made after the adminis-in renal perfusion induced by propranolol has tration of propranolol. Indeed, numerous studies been widely attributed to the fall in cardiac have demonstrated a propranolol-induced output (Sannerstedt & Conway, 1970;Nies et reduction in renal blood flow and, where it was al., 1971). Alternatively, it has been suggested measured, in glomerular filtration rate (for that the renal response to propranolol (and references see: Weber & Drayer, 1980; Epstein presumably to other P-adrenoceptor blockers) 94 A. G. Dupont et al 1969;Fenyvesi & Kallay, 1970;Sullivan et al, 1976).…”

Section: Introductionmentioning

confidence: 99%

Nadolol in essential hypertension: effect on ambulatory blood pressure, renal haemodynamics and cardiac function.

Ag¹,

Vanderniepen²,

Am³

et al. 1985

Brit J Clinical Pharma

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Chronic administration of nadolol has been reported to reduce blood pressure either without or with a concomitant fall of renal blood flow. We therefore studied the effects of nadolol 80 mg once daily on ambulatory blood pressure, renal and systemic haemodynamics in patients with mild to moderate essential hypertension. Ten patients took part in this randomized, double‐blind, placebo‐controlled, crossover study, each phase of which lasted 4 weeks. Nadolol significantly reduced ambulatory blood pressure and heart rate, but had no effect on blood pressure variability. Cardiac output was significantly reduced by nadolol and total peripheral resistance increased but without reaching statistical significance. Despite the fall in blood pressure and cardiac output, renal blood flow and glomerular filtration rate remained unchanged. The fraction of cardiac output reaching the kidneys rose significantly and renal vascular resistance was significantly reduced. Body weight, urinary sodium excretion and urine flow rate remained unchanged. We conclude that nadolol 80 mg once daily lowers ambulatory blood pressure in patients with mild to moderate hypertension without impairment of renal blood flow, indicating a redistribution of cardiac output to the kidneys. The mechanism of the renal vasodilator effect of nadolol remains to be determined.

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“…Because a reduction in renal blood flow and glomerular filtration rate are common with agents that reduce cardiac output (Sannerstedt & Conway, 1970), as does propranolol, the renal response was widely attributed to the systemic effects of the agent. On that basis a reduction in renal blood flow would be anticipated in response to other P-adrenoceptor-blocking agents, as has been indeed demonstrated for dichloroisoproterenol, oxprenolol, and pindolol (Cooper et al, 1967;Bufano & Piacentini, 1969;Abdel-Razzak, 1977;Heierli et al, 1977).…”

Section: Introductionmentioning

confidence: 99%

beta‐Adrenoceptor‐blocking agents and the kidney: effect of nadolol and propranolol on the renal circulation.

Hollenberg¹,

Adams²,

McKinstry³

et al. 1979

Brit J Clinical Pharma

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1 Nadolol was administered intravenously to five hypertensive patients and three healthy volunteers in balance on a 10 mEq sodium intake. 2 Nadolol (0.3-10.0,ug/kg) induced a significant, dose-related increase in renal blood flow, measured with radioxenon, with a maximum increase of 72 ± 4 ml/100g/min (26%) at 3.0 .g/kg. 3 Heart rate and plasma renin activity decreased significantly over the same dose range. 4 The renal vascular response to nadolol contrasts sharply with those found with other P-adrenoceptor-blocking agents.5 The magnitude ofthe increase in renal blood flow, its time-course and the parallel fall in plasma renin activity raise the possibility that the renal vasodilatation reflects the reversal of angiotensin's influence on the renal arterial bed.

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Hemodynamic and vascular responses to antihypertensive treatment with adrenergic blocking agents: A review

Cited by 59 publications

References 36 publications

Short- and long-term efficacy of a calcium-antagonistic agent (nifedipine) combined with methyldopa in the treatment of severe hypertension.

Short- and long-term efficacy of a calcium-antagonistic agent (nifedipine) combined with methyldopa in the treatment of severe hypertension.

Nadolol in essential hypertension: effect on ambulatory blood pressure, renal haemodynamics and cardiac function.

beta‐Adrenoceptor‐blocking agents and the kidney: effect of nadolol and propranolol on the renal circulation.

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