Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

Müller, M; Ahmad, Tariq; Pelaez, Alvaro F. Vargas; Proctor, David N.; Bonavia, Anthony; Luck, Jerry C.; Maman, Stephan R.; Ross, Amanda; Leuenberger, Urs A.; McQuillan, Patrick

doi:10.1152/japplphysiol.00940.2016

Cited by 4 publications

(11 citation statements)

References 61 publications

(77 reference statements)

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“…Exercise and infusion protocols have been previously described (Muller et al. ) and are outlined in Figure . Based on data obtained in previous studies and clinical guidelines (Muller et al.…”

Section: Methodsmentioning

confidence: 99%

“…Based on data obtained in previous studies and clinical guidelines (Muller et al. ), we chose to administer esmolol hydrochloride (2500 mg in 250 mL) intravenously as 0.5 mg/kg FFM/min for 3 min followed by 0.25 mg/kg FFM/min maintenance dose.…”

Section: Methodsmentioning

confidence: 99%

“…Light and moderately intense bouts of exercise were determined by a target HR of 110 beats/min and 150 beats/min, respectively. Exercise and infusion protocols have been previously described (Muller et al 2017) and are outlined in Figure 1. Based on data obtained in previous studies and clinical guidelines (Muller et al 2017), we chose to administer esmolol hydrochloride (2500 mg in 250 mL) intravenously as 0.5 mg/kg FFM/min for 3 min followed by 0.25 mg/kg FFM/min maintenance dose.…”

Section: Protocol and Methodsmentioning

confidence: 99%

“…We recently established that infusion of ~160 mg of esmolol (range 110–200 mg in the 5 min before exercise) acutely and selectively blocks β 1 receptors (Muller et al. ). The rapid half‐life of esmolol permitted us to assess SmO 2 in the presence and subsequent absence of esmolol in a single visit, while keeping the NIRS probes in a constant location.…”

Section: Introductionmentioning

confidence: 99%

“…Esmolol hydrochloride (Brevibloc, Baxter Healthcare) is commonly used in clinical practice, with an elimination half-life of <10 min due to metabolism by red blood cell esterases (Harless et al 2015;Sum et al 1983). We recently established that infusion of~160 mg of esmolol (range 110-200 mg in the 5 min before exercise) acutely and selectively blocks b 1 receptors (Muller et al 2017). The rapid half-life of esmolol permitted us to assess SmO 2 in the presence and subsequent absence of esmolol in a single visit, while keeping the NIRS probes in a constant location.…”

Section: Introductionmentioning

confidence: 99%

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Esmolol acutely alters oxygen supply-demand balance in exercising muscles of healthy humans

et al. 2018

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Beta‐adrenoreceptor antagonists (β blockers) reduce systemic O2 delivery and blood pressure (BP) during exercise, but the subsequent effects on O2 extraction within the active limb muscles are unknown. In this study, we examined the effects of the fast‐acting, β 1 selective blocker esmolol on systemic hemodynamics and leg muscle O2 saturation (near infrared spectroscopy, NIRS) during submaximal leg ergometry. Our main hypothesis was that esmolol would augment exercise‐induced reductions in leg muscle O2 saturation. Eight healthy adults (6 men, 2 women; 23–67 year) performed light and moderate intensity bouts of recumbent leg cycling before (PRE), during (β 1‐blocked), and 45 min following (POST) intravenous infusion of esmolol. Oxygen uptake, heart rate (HR), BP, and O2 saturation (SmO2) of the vastus lateralis (VL) and medial gastrocnemius (MG) muscles were measured continuously. Esmolol attenuated the increases in HR and systolic BP during light (−12 ± 9 bpm and −26 ± 12 mmHg vs. PRE) and moderate intensity (−20 ± 10 bpm and −40 ± 18 mmHg vs. PRE) cycling (all P < 0.01). Exercise‐induced reductions in SmO2 occurred to a greater extent during the β 1‐blockade trial in both the VL (P = 0.001 vs. PRE) and MG muscles (P = 0.022 vs. PRE). HR, SBP and SmO2 were restored during POST (all P < 0.01 vs. β 1‐blocked). In conclusion, esmolol rapidly and reversibly increases O2 extraction within exercising muscles of healthy humans.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Protocol and Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Esmolol acutely alters oxygen supply-demand balance in exercising muscles of healthy humans

et al. 2018

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Influence of myocardial oxygen demand on the coronary vascular response to arterial blood gas changes in humans

Vermeulen

Boulet

Stembridge

et al. 2018

American Journal of Physiology-Heart and Circulatory Physiology

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It remains unclear if the human coronary vasculature is inherently sensitive to changes in arterial Po and Pco or if coronary vascular responses are the result of concomitant increases in myocardial O consumption/demand ([Formula: see text]). We hypothesized that the coronary vascular response to Po and Pco would be attenuated in healthy men when [Formula: see text] was attenuated with β-adrenergic receptor blockade. Healthy men (age: 25 ± 1 yr, n = 11) received intravenous esmolol (β-adrenergic receptor antagonist) or volume-matched saline in a double-blind, randomized crossover study and were exposed to poikilocapnic hypoxia, isocapnic hypoxia, and hypercapnic hypoxia. Measurements made at baseline and after 5 min of steady state at each gas manipulation included left anterior descending coronary blood velocity (LAD; Doppler echocardiography), heart rate, and arterial blood pressure. LAD values at the end of each hypoxic condition were compared between esmolol and placebo. The rate-pressure product (RPP) and left ventricular mechanical energy (ME) were calculated as indexes of [Formula: see text]. All gas manipulations augmented RPP, ME, and LAD, but only RPP and ME were attenuated (4-18%) after β-adrenergic receptor blockade ( P < 0.05). Despite attenuated RPP and ME responses, β-adrenergic receptor blockade did not attenuate the mean LAD vasodilatory response compared with placebo during poikilocapnic hypoxia (29.4 ± 2.2 vs. 27.3 ± 1.6 cm/s) and isocapnic hypoxia (29.5 ± 1.5 vs. 30.3 ± 2.2 cm/s). Hypercapnic hypoxia elicited a feedforward coronary dilation that was blocked by β-adrenergic receptor blockade. These results indicate a direct influence of arterial Po on coronary vascular regulation that is independent of [Formula: see text]. NEW & NOTEWORTHY In humans, arterial hypoxemia led to an increase in epicardial coronary artery blood velocity. β-Adrenergic receptor blockade did not diminish the hypoxemic coronary response despite reduced myocardial O demand. These data indicate hypoxemia can regulate coronary blood flow independent of myocardial O consumption. A plateau in the mean left anterior descending coronary artery blood velocity-rate-pressure product relationship suggested β-adrenergic receptor-mediated, feedforward epicardial coronary artery dilation. In addition, we observed a synergistic effect of Po and Pco during hypercapnic hypoxia.

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Beta-1 vs. beta-2 adrenergic control of coronary blood flow during isometric handgrip exercise in humans

Maman

Vargas

Ahmad

et al. 2017

Journal of Applied Physiology

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During exercise, β-adrenergic receptors are activated throughout the body. In healthy humans, the net effect of β-adrenergic stimulation is an increase in coronary blood flow. However, the role of vascular β1 vs. β2 receptors in coronary exercise hyperemia is not clear. In this study, we simultaneously measured noninvasive indexes of myocardial oxygen supply (i.e., blood velocity in the left anterior descending coronary artery; Doppler echocardiography) and demand [i.e., rate pressure product (RPP) = heart rate × systolic blood pressure) and tested the hypothesis that β1 blockade with esmolol improves coronary exercise hyperemia compared with nonselective β-blockade with propranolol. Eight healthy young men received intravenous infusions of esmolol, propranolol, and saline on three separate days in a single-blind, randomized, crossover design. During each infusion, subjects performed isometric handgrip exercise until fatigue. Blood pressure, heart rate, and coronary blood velocity (CBV) were measured continuously, and RPP was calculated. Changes in parameters from baseline were compared with paired -tests. Esmolol (Δ = 3296 ± 1204) and propranolol (Δ = 2997 ± 699) caused similar reductions in peak RPP compared with saline (Δ = 5384 ± 1865). In support of our hypothesis, ΔCBV with esmolol was significantly greater than with propranolol (7.3 ± 2.4 vs. 4.5 ± 1.6 cm/s; = 0.002). This effect was also evident when normalizing ΔCBV to ΔRPP. In summary, not only does selective β1 blockade reduce myocardial oxygen demand during exercise, but it also unveils β2-receptor-mediated coronary exercise hyperemia. In this study, we evaluated the role of vascular β1 vs. β2 receptors in coronary exercise hyperemia in a single-blind, randomized, crossover study in healthy men. In response to isometric handgrip exercise, blood flow velocity in the left anterior descending coronary artery was significantly greater with esmolol compared with propranolol. These findings increase our understanding of the individual and combined roles of coronary β1 and β2 adrenergic receptors in humans.

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Esmolol infusion versus propranolol infusion: effects on heart rate and blood pressure in healthy volunteers

Cited by 4 publications

References 61 publications

Esmolol acutely alters oxygen supply-demand balance in exercising muscles of healthy humans

Esmolol acutely alters oxygen supply-demand balance in exercising muscles of healthy humans

Influence of myocardial oxygen demand on the coronary vascular response to arterial blood gas changes in humans

Beta-1 vs. beta-2 adrenergic control of coronary blood flow during isometric handgrip exercise in humans

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