Right ventricular performance in essential hypertension after beta-blockade.

Abstract

SUMMARY Recent studies indicate that right ventricular performance is impaired even in uncomplicated systemic hypertension. Because ofwidespread use ofbeta-blockade in essential hypertension, it is possible that such treatment often further depresses right ventricular contractility. To test this premise, and to evaluate the changes induced by different beta-adrenoceptor blocking agents on the contractility of right ventricular myocardium, 20 patients with essential hypertension were divided into two groups on a double-blind randomised basis, and maintained on oral oxprenolol or propranolol for five weeks. Cardiac catheterisation and right ventricular cineangiography were performed at the beginning and again at the end of the five week period. Right ventricular end-diastolic volume index did not change significantly in either group. In contrast, right ventricular end-systolic volume index increased, and right ventricular ejection fraction significantly decreased after chronic beta-blockade. Cardiac index decreased in both groups, but these changes were not statistically significant.When the intergroup differences were compared for all measured indices none of the changes between the two groups was statistically significant. Despite its intrinsic sympathomimetic activity, oxprenolol therefore impairs right ventricular performance to an extent nearly equal to that of propranolol. Moreover, right ventricular contractility is clearly diminished after the institution of beta-blockade in hypertensive patients-an effect that has until now been thought to be limited to the left side of the heart. Great caution must therefore be exercised when beta-blockade is initiated in patients with severely abnormal right ventricular function, because frank right ventricular decompensation may result.Recent studies in our laboratory have shown a commonly accepted concept-that right ventricular function is normal in uncomplicated systemic hypertension-to be incorrect. Right ventricular performance diminishes even with early abnormal increases in arterial pressure.' Because systemic hypertension is frequently treated with beta-blockade, it was essential to determine how such treatment affects the integrity of the right heart which is already compromised by the hypertension itself.The effects of beta-blockade on left ventnrcular performance have been extensively investigated.2-6 There is a virtually unanimous agreement that one ofthe most commonly used beta antagonists, propranolol, depresses left ventricular contractility.7-9 More controversy, however, surrounds some of the newer experimental beta-adrenergic blocking agents, especially those that Received for publication 5 September 1980 possess intrinsic sympathomimetic activity. Moreover, the effects on right ventricular performance generated by beta-blockers with or without intrinsic sympathomimetic activity are still completely unknown.Oxprenolol, which is still not approved for general clinical use in the United States, possesses intrinsic sympathominx tic activity. I0-13 When the...

Multifaced risk factors and clinical impact of a deep Y descent in patients with heart failure irrespective of RV-PA coupling

“…An invasive examination of the acute effects of an infusion with the beta-blocker, esmolol in patients with PA hypertension showed increases in the RV end diastolic volume instead of heart rate with exercise [23] . Moreover, Ferlinz et al reported that the long-term use of the beta-blockers, oxprenolol and propranolol, increased RV end-diastolic pressure and decreased RVEF in patients with essential hypertension, which indicated that the long-term use of beta-blockers impairs RV diastolic function [24] . Therefore, the negative chronotropic and inotropic effects of beta-blockers may lead to a decreased RV preload reserve and a deep Y descent due to RV volume overload.…”