This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kern, M. J. Articles by Mudge, G. H. Search for Related Content PubMed PubMed Citation Articles by Kern, M. J. Articles by Mudge, G. H., Jr

Circulation, Vol 67, 1178-1185, Copyright © 1983 by American Heart Association

ARTICLES

Potentiation of coronary vasoconstriction by beta-adrenergic blockade in patients with coronary artery disease

MJ Kern, P Ganz, JD Horowitz, J Gaspar, WH Barry, BH Lorell, W Grossman and GH Mudge Jr

Although beta-adrenergic blocking agents reduce myocardial oxygen consumption and symptoms of myocardial ischemia in patients with coronary artery disease (CAD), propranolol has been reported to exacerbate coronary artery spasm in some patients with variant angina. To determine whether increased coronary vasomotor tone can be induced by beta-adrenergic blockade, we measured the changes in coronary vascular resistance (CVR) during cold pressor testing (CPT) in 15 patients, nine with severe CAD and six with normal left coronary anatomy, before and after i.v. propranolol (0.1 mg/kg). Coronary blood flow was measured by coronary sinus thermodilution. CVR was calculated as mean arterial pressure divided by coronary sinus blood flow. Heart rate was maintained constant at a paced subanginal rate of 95 +/- 5 beats/min. Before propranolol, CPT induced significant increases in coronary vascular resistance in patients with CAD (15.0 +/- 2.2%, p less than 0.02), but no increase in CVR in the normal patients. After propranolol, the CVR change during CPT was augmented for patients with CAD (29 +/- 6%, p less than 0.01) and for the normal population (9 +/- 5%, NS). The potentiated increase in CVR occurred without significant changes in resting CVR or in the magnitude of the hypertensive response to CPT. We conclude that beta-adrenergic blockade with propranolol can potentiate coronary artery vasoconstriction in some patients with CAD, possibly mediated by unopposed alpha-adrenergic vasomotor tone. These changes may be important in patients in whom intense adrenergic stimulation may increase coronary artery tone and adversely influence the balance between myocardial oxygen supply and demand.

This article has been cited by other articles:

				E. Barbato, F. Piscione, J. Bartunek, G. Galasso, P. Cirillo, G. De Luca, G. Iaccarino, B. De Bruyne, M. Chiariello, and W. Wijns Role of {beta}2 Adrenergic Receptors in Human Atherosclerotic Coronary Arteries Circulation, January 25, 2005; 111(3): 288 - 294. [Abstract] [Full Text] [PDF]

				P. Koepfli, C. A. Wyss, M. Namdar, M. Klainguti, G. K. von Schulthess, T. F. Luscher, and P. A. Kaufmann {beta}-Adrenergic Blockade and Myocardial Perfusion in Coronary Artery Disease: Differential Effects in Stenotic Versus Remote Myocardial Segments J. Nucl. Med., October 1, 2004; 45(10): 1626 - 1631. [Abstract] [Full Text] [PDF]

				M. Billinger, L. Raeber, C. Seiler, S. Windecker, B. Meier, and O. M. Hess Coronary collateral perfusion in patients with coronary artery disease: effect of metoprolol Eur. Heart J., April 1, 2004; 25(7): 565 - 570. [Abstract] [Full Text] [PDF]

				M. J. Kern Dobutamine and the coronary vasomotion paradox J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1602 - 1604. [Full Text] [PDF]

				L. M. Riou, M. Ruiz, J. M. Rieger, T. L. Macdonald, D. D. Watson, J. Linden, G. A. Beller, and D. K. Glover Influence of propranolol, enalaprilat, verapamil, and caffeine on adenosine A2A-receptor-mediated coronary vasodilation J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1687 - 1694. [Abstract] [Full Text] [PDF]

				D. Sun, A. Huang, S. Mital, M. R. Kichuk, C. C. Marboe, L. J. Addonizio, R. E. Michler, A. Koller, T. H. Hintze, and G. Kaley Norepinephrine Elicits {beta}2-Receptor-Mediated Dilation of Isolated Human Coronary Arterioles Circulation, July 30, 2002; 106(5): 550 - 555. [Abstract] [Full Text] [PDF]

				M. Billinger, C. Seiler, M. Fleisch, F. R. Eberli, B. Meier, and O. M. Hess Do beta-adrenergic blocking agents increase coronary flow reserve? J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1866 - 1871. [Abstract] [Full Text] [PDF]

				R. A. Lange, R. G. Cigarroa, E. D. Flores, W. McBride, A. S. Kim, P. J. Wells, J. B. Bedotto, R. S. Danziger, and L. D. Hillis Potentiation of Cocaine-Induced Coronary Vasoconstriction by Beta-Adrenergic Blockade Ann Intern Med, June 15, 1990; 112(12): 897 - 903. [Abstract] [PDF]

				E. Johnson and T. Ports Unstable Angina Pectoris: An Interventional Approach to Management J Intensive Care Med, July 1, 1988; 3(4): 202 - 214. [Abstract] [PDF]

				J. Z. Przybojewski and P. H. Becker Angina Pectoris and Acute Myocardial Infarction Due to "Slow-Flow Phenomenon" in Nonatherosclerotic Coronary Arteries: A Case Report Angiology, October 1, 1986; 37(10): 751 - 761. [Abstract] [PDF]