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Adrenergic Blockade in Hypertension FREE

Jawahar Mehta, MD
[+] Author Affiliations

Reprint requests to Division of Cardiology, Department of Medicine, Box J-277, JHM Health Center, Gainesville, FL 32610 (Dr Mehta).


JAMA. 1978;240(16):1759-1760. doi:10.1001/jama.1978.03290160077035
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HYPERTENSION with its sequelae is the second most common cause of death after atherosclerosis in the United States. A great deal of work has been done in the past decade to define the pathogenesis and to rationalize therapy for so-called essential hypertension. There is a suggestion that hyperactivity of the central and peripheral sympathetic nervous system either in response to stress or de novo leads to hypertension in some patients. A decline in blood pressure (BP) in hospitalized patients and during relaxation states (eg, meditation) lends support to this theory.

Experimental application of epinephrine to hypothalamic or medullary receptors has resulted in sympathetic discharge and an increase in systemic BP. Some persons have been shown to have hyperdynamic circulation characterized by high plasma catecholamine levels, tachycardia, systemic hypertension, and high cardiac output in the early phase of hypertension. Long-standing hypertension increases the sodium content of the arteriolar wall and eventually

REFERENCES

Laragh JH, Baer L, Brunnel HR, et al:  Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease . Am J Med 52:633-652, 1972;.
Shinebourne E, Fleming J, Hamer J:  Effects of beta-adrenergic blockade during exercise in hypertensive and ischaemic heart disease . Lancet 2:1217-1220, 1967;.
Tarazi RC, Dustan HP:  Beta adrenergic blockade in hypertension: Practical and theoretical implications of long-term hemodynamic variations . Am J Cardiol 29:633-640, 1972;.
Hollifield JW, Sherman K, Zwaag RV, et al:  Proposed mechanism of propranolol's antihypertensive effect in essential hypertension . N Engl J Med 295:68-73, 1976;.
Vlachakis ND, Mendlowitz M:  An approach to the treatment of essential hypertension . Am Heart J 92:750-757, 1976;.
Mehta J, Cohn JN:  Hemodynamic effects of labetalol, an alpha and beta adrenergic blocking agent, in hypertensive subjects . Circulation 55:370-375, 1977;.

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Laragh JH, Baer L, Brunnel HR, et al:  Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease . Am J Med 52:633-652, 1972;.
Shinebourne E, Fleming J, Hamer J:  Effects of beta-adrenergic blockade during exercise in hypertensive and ischaemic heart disease . Lancet 2:1217-1220, 1967;.
Tarazi RC, Dustan HP:  Beta adrenergic blockade in hypertension: Practical and theoretical implications of long-term hemodynamic variations . Am J Cardiol 29:633-640, 1972;.
Hollifield JW, Sherman K, Zwaag RV, et al:  Proposed mechanism of propranolol's antihypertensive effect in essential hypertension . N Engl J Med 295:68-73, 1976;.
Vlachakis ND, Mendlowitz M:  An approach to the treatment of essential hypertension . Am Heart J 92:750-757, 1976;.
Mehta J, Cohn JN:  Hemodynamic effects of labetalol, an alpha and beta adrenergic blocking agent, in hypertensive subjects . Circulation 55:370-375, 1977;.
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