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(Circulation. 1969;40:501.)
© 1969 American Heart Association, Inc.

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Cardiovascular Pharmacology of Propranolol in Man

STEVEN WOLFSON M.D.¹ RICHARD GORLIN M.D.¹

¹ From the Cardiovascular Division, Department of Medicine, Peter Bent Brigham Hospital and Harvard Medical School, Boston, Massachusetts. Dr. Gorlin is an Investigator, Howard Hughes Medical Institute.

The success of propranolol in treating the symptoms of angina pectoris has raised questions about the effects of beta-adrenergic blockade on the hemodynamic functions, myocardial mechanics, energetics, and metabolic functions. Five milligrams of propranolol was given intravenously to 27 human subjects, 18 with and nine without angiographically proven coronary atherosclerosis. The drug produced a decrease in externally measured indices of myocardial mechanical effort and consequently a fall in myocardial oxygen demands. The hemodynamic changes and resultant increases in myocardial oxygen consumption and coronary flow during supine leg exercise were also attenuated. Propranolol produced different changes in myocardial arteriovenous oxygen extraction depending upon whether the coronary circulation was normal or diseased. Although the data suggest that coronary vasoconstriction occurred in patients with atherosclerotic lesions, no significant change in myocardial lactate exchange was noted after administration of propranolol. Beta-adrenergic blockade caused a decline in cardiac filling pressures and volumes at the dose level used in this study, presumably by decreasing venous return.

Key Words: Coronary blood flow • Myocardial lactate-pyruvate exchange • Beta-adrenergic blockade • Left ventricular volume • Left ventricular pressure • Myocardial O₂ consumption • Physical exercise

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