Treatment of Hypertension with Propranolol

TLDR

Propranolol is as potent as other antihypertensives, does not cause postural or exercise hypotension, is generally better tolerated, and its maximal effect occurs after six to eight weeks. Propranolol lowers cardiac output and attenuates pressor stimuli, allowing baroreceptors to gradually set a lower blood‑pressure level and yielding superior supine BP control. In a cohort of 109 patients, 92 achieved supine or standing BP ≤ 100 mmHg, and in a subset of 17, propranolol produced lower diastolic pressures than guanethidine, bethanidine, or methyldopa; sensitivity varies, requiring gradual dose escalation, and it is contraindicated in obstructive airway disease or uncompensated heart failure.

Abstract

When used in the treatment of hypertension propranolol is at least of similar potency to bethanidine, guanethidine, and methyldopa. Propranolol does not produce postural or exercise hypotension and it seems that it is often more acceptable to patients than conventional drugs. It usually produces the best control of the supine blood pressure.A series of 109 hypertensive patients was treated with propranolol; in nine the drug was withdrawn. In 92 of the patients a supine or standing blood pressure of 100 mm. Hg or less was achieved. Eighty of the patients had previously been treated with other potent drugs, and close comparisons and prolonged follow-up in 17 patients showed that diastolic pressures of 100 mm. Hg or less were achieved in more patients after propranolol than with guanethidine, bethanidine, or methyldopa.Sensitivity to propranolol varies widely, and dosage should be increased gradually. The hypotensive effect often takes six to eight weeks to reach its maximum. Propranolol reduces cardiac output but may also act by reducing the cardiac component of pressor stimuli; as a result the baroreceptors gradually regulate the blood pressure at a lower level. It is contraindicated in patients with obstructive airways disease or in uncompensated heart failure.