Responses to mental stress and physical provocations before and during long term treatment of hypertensive patients with beta‐adrenoceptor blockers or hydrochlorothiazide.

Abstract

1 Cardiovascular and sympatho-adrenal responsiveness to mental stress (CWT; a colour word test), orthostatic testing (ORT) and a cold pressor test (CPT) were examined in three groups of hypertensive patients (n = 14-16) before and after 6 months treatment with metoprolol (243 ± 26 mg daily), propranolol (149 ± 16 mg daily) or hydrochlorothiazide (50 ± 8 mg daily) in an open trial design. 2 Treatment reduced outpatient blood pressures in the three groups similarly (from approximately 155/102 to 135/90 mm Hg). During treatment resting blood pressures in the laboratory were clearly reduced by P-adrenoceptor blockade but not by thiazide treatment. Metoprolol and propranolol caused similar reductions of basal heart rates and plasma glycerol levels, whereas only propranolol reduced cyclic AMP concentrations in plasma. 3 Before treatment CWT and CPT increased systolic and diastolic blood pressures by about 30%. Heart rate increased by about 30 beats min-' during CWT and 10-15 beats min-' during CPT and ORT. Small venous plasma adrenaline responses were evoked by all tests, whereas noradrenaline was elevated mainly by CPT and ORT. Dopamine levels did not change. 4 Heart rate responses to all stressors were markedly and similarly reduced, whereas blood pressure responses were essentially unchanged during metoprolol or propranolol treatment. In the thiazide group circulatory responses to CWT were slightly attenuated, whereas responses to ORT and CPT were unchanged. 5 The systolic blood pressure levels were reduced throughout the test session in all three groups, although less so in the hydrochlorothiazide group. Both 3-adrenoceptor antagonists clearly reduced diastolic blood pressure and heart rate levels at rest and during stress, whereas thiazide treatment caused no significant changes in these respects. 6 The rate pressure product, which increased by 80-100% in response to CWT before treatment, was more markedly reduced by 3-adrenoceptor blockade than by thiazide treatment both at rest and during stress.7 Self ratings (visual analogue scales) of stress and irritation were increased by CWT in a similar fashion before and during treatment in all groups. ,B-adrenoceptor blockade was associated with higher subjective ratings of tiredness at rest, but not after CWT. Perfor-

Effects of mental and physical stress on plasma catecholamine levels before and afterβ-adrenoceptor blocker treatment

“…Bonelli et al [32] also found that propranolol did not affect the calculation stress-induced increase in E. On the other hand, mepindolol, which is similar to bopindolol, prevented the increase, in contrast to the present finding. The effect of 13-adrenoceptor blockers on the response to mental stress was also studied by Etiasson et al [36]. They found that the response of NE was increased by propranolol, but not by metoprolol, and that plasma E was decreased by metoprolol.…”

Central integration and neural control of blood pressure during the cold pressor test: a comparison between hydrochlorothiazide and aliskiren

“…1986, 1987). While these studies did not examine MSNA responses, one reported that BP responsiveness was the same before and after 6 months of hydrochlorothiazide treatment (Eliasson et al.…”

“…While these studies did not examine MSNA responses, one reported that BP responsiveness was the same before and after 6 months of hydrochlorothiazide treatment (Eliasson et al. 1987). Their subject population was dissimilar to ours; their subjects were younger (˜40-years old) and required a higher dose of HCTZ (50 mg) to control BP (Eliasson et al.…”

“…Their subject population was dissimilar to ours; their subjects were younger (˜40-years old) and required a higher dose of HCTZ (50 mg) to control BP (Eliasson et al. 1987). However, our findings combined with those of Eliasson et al.…”

“…However, our findings combined with those of Eliasson et al. (1987) underscore that responsiveness to stressors should be an important consideration when treating those with hypertension.…”