Drugs

, Volume 7, Issue 1–2, pp 8–38 | Cite as

Pharmacodynamic Properties of β-Adrenergic Receptor Blocking Drugs in Man

  • D. G. Gibson
Review Article

Summary

β-Adrenergic receptor blocking drugs have been in clinical use for over 10 years, and have allowed pharmacological manipulation of one of the fundamental homeostatic mechanisms of the cardiovascular system. Their cardiac actions, namely a reduction in heart rate, a change in the pattern of left ventricular contraction and prolongation of atrioventricular conduction, are all explicable on the basis of inhibition of adrenergic receptors. Although ‘quinidine-like’ effects and partial agonist activity have been demonstrated pharmacologically, there is no evidence to suggest that they lead to any significant modification of the properties of β-adrenergic receptor blocking drugs given in therapeutic dosage.

In the peripheral vasculature, the presence of adrenergic vasodilator activity has been demonstrated in the splanchnic and myocardial circulations. The use of relatively selective drugs such as practolol has allowed the response to cardiac blockade to be dissociated from these peripheral effects, and has suggested that the actions of non-selective drugs on arterial pressure and cardiac output are mediated by changes in the peripheral vasculature as well as the heart.

Additional factors of haemodynamic importance are a reduction in plasma volume which has been ascribed to altered vasomotor activity in the peripheral circulation, and inappropriate renal sodium handling which may lead to fluid retention in patients with heart disease. The significance of the suppression of renin secretion by propranolol is still not clear, but its use as a pharmacological tool may contribute to an increased understanding of the physiological importance of the renin-angiotensin system.

Adrenergic stimulation also induces important metabolic effects which cannot readily be classified in terms of α - and β-receptor sites with properties similar to those of smooth muscle or heart. Propranolol blocks stimulatory effects on muscle glycolysis, lipolysis and insulin secretion, and an inhibitory effect on growth hormone release, whilst practolol is considerably less effective when doses with equal cardiovascular effects are compared. It seems likely that further understanding of these alterations in metabolic activity will demonstrate the relation between them and local blood flow, thus giving a clearer picture of the overall response of the cardiovascular system to β-adrenergic blockade.

Key Words

β-Adrenergic receptor blocking drugs Adrenergic receptors Carbohydrate metabolism Cardiovascular system Circulation, peripheral Cyclic AMP Fatty acids, free Growth hormone Haemodynamics, cardiovascular Renin secretion 

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Copyright information

© Adis Press 1974

Authors and Affiliations

  • D. G. Gibson
    • 1
  1. 1.Department of CardiologyBrompton HospitalLondonEngland

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