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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