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.



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


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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