A pAdrenergic receptor blockers

1. p-blockers are recommended first-line agents in uncomplicated hypertension, or in hypertensive patients with angina pectoris, cardiac arrhythmias, mitral valve prolapse, a history of myocardial infarction (MI), diastolic dysfunction, or migraine headaches. p-blockers are preferred in young Caucasian hypertensive patients (younger than 40-50). African-Americans tend to respond less well to p-blockers.

2. Common adverse effects of p-blockers include decreased exercise tolerance, cold extremities, depression, sleep disturbance, and impotence, although these side effects may be less severe with the p1-selective blockers (ie, metoprolol, atenolol, bisoprolol). The use of p1-selective agents also helps minimize adverse effects associated with p2-blockade (suppression of insulin release, promotion of bronchospasm). All p-blockers can exacerbate asthma, peripheral vascular disease, and diabetes at high doses.

3. p-blockers should be used with caution in patients with bronchospastic disease, and nonselective agents are contraindicated in these patients. Agents with ISA (acebutolol, pindolol, carteolol, penbutolol) partially stimulate the p-receptor while they antagonize it. The advantages of these agents include less resting bradycardia as well as neutral effects on lipid and glucose metabolism.

ß-blockers

Drug

Usual dose

Maximum dose

Acebutolol (Sectral)

200-800 mg/d (qd or bid)

1.2 g/d (bid)

Atenolol (Tenormin)

50-100 mg qd

100 mg qd

Betaxolol (Kerlone)

10 mg qd

20 mg qd

Bisoprolol (Zebeta)

5 mg qd

20 mg qd

Carteolol (Cartrol)

2.5 mg qd

10 mg qd

Metoprolol succinate (Toprol XL)

100-200 mg qd

400 mg qd

Metoprolol tartrate (Lopressor)

100-200 mg/d (qd or bid)

450 mg/d (qd or bid)

Nadolol (Corgard)

40 mg qd

320 mg/d

Penbutolol sulfate (Levatol)

20 mg qd

NA

Pindolol (Visken)

5 mg bid

60 mg/d

Propranolol (Inderal, Inderal LA)

120-160 mg qd (LA 640 mg/d)

Timolol (Blocadren)

10-20 mg bid

60 mg/d (bid)

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