Effect of beta-adrenergic blockade on circulating catecholamines and dopamine-beta-hydroxylase activity during exercise in normal subjects

Acute changes in forearm vascular compliance during transient sympatho-excitation

The study of vascular regulation often omits important information about the elastic properties of arteries under conditions of pulsatile flow. The purpose of this study was to examine the relationship between muscle sympathetic nerve activity (MSNA), vascular bed compliance, and peripheral blood flow responses in humans. We hypothesized that increases in MSNA would correlate with reductions in vascular compliance, and that changes in compliance would correspond with changes in peripheral blood flow during sympatho-excitation. MSNA (microneurography), blood pressure (Finopres), and brachial artery blood flow (Doppler ultrasound), were monitored in six healthy males at baseline and during the last 15 s of voluntary end-inspiratory, expiratory apneas and 5 min of static handgrip exercise (SHG; 20% maximum voluntary contraction) and 3 min of post-exercise circulatory occlusion (SHG + PECO; measured in the non-exercising arm). A lumped Windkessel model was employed to examine vascular bed compliance. During apnea, indices of MSNA were inversely related with vascular compliance, and reductions in compliance correlated with decreased brachial blood flow rate. During SHG, despite increased MSNA, compliance also increased, but was unrelated to increases in blood flow. Neither during SHG nor PECO did indices of MSNA correlate with forearm vascular compliance nor did vascular compliance correlate with brachial flow. However, during PECO, a linear combination of blood pressure and total MSNA was correlated with vascular compliance. These data indicate the elastic components of the forearm vasculature are regulated by adrenergic and myogenic mechanisms during sympatho-excitation, but in a reflex-dependent manner.

Urinary adrenalin and cortisol secretion patterns of social voles in response to adrenergic blockade under basal conditions

The effect of alpha(1)- and beta-adrenergic blockade on daily rhythms of urinary adrenalin (ADR) and cortisol (CORT) under basal conditions were evaluated. Voles acclimated to a 12:12 h light/dark cycle at 26+/-2 degrees C received a single dose of either propranolol (PROP; 4.5 mg/kg) or prazosin (PRAZ; 1 mg/kg) 1 h before lights off. Urine samples were collected for 24 h at 4 h intervals. PROP evokes a significant increase in mean urinary ADR; although CORT was unaffected by PROP, PRAZ administration significantly decreased both urinary ADR and CORT during the scotophase as compared with control voles. Cosinor analysis indicated a significant 24 h rhythm in urinary ADR, but not in CORT secretion. ADR mesor and amplitude were increased and acrophase was significantly delayed by 5 h in PROP-treated voles; PRAZ elicited opposite effects. Unexpectedly, these changes in the 24 h ADR rhythm persisted 4-weeks after PROP-treatment. The 24 h rhythm components of urinary CORT were marginally altered 4-weeks post-PROP, but only the acrophase showed a significant change. Collectively, the results indicate that sympathetic activity has a redundant compensatory mechanism defending against physiological changes induced by beta-blockade. The simultaneous decrease in adrenal hormones induced by PRAZ suggests that alpha(1)-adrenoceptors may contribute to the mechanism of integrated stress responses.

Effect of adrenergic blockade on lymphocyte cytokine production at rest and during exercise

To examine the effect of exercise and adrenergic blockade on lymphocyte cytokine production, six men ingested either a placebo (control) or an alpha- (prazosin hydrochloride) and beta-adrenoceptor antagonist (timolol malate) capsule (blockade, or BLK) 2 h before performing 19 +/- 1 min of supine bicycle exercise at 78 +/- 3% peak pulmonary uptake. Blood was collected before and after exercise, stimulated with phorbol 12-myristate 13-acetate and ionomycin, and surface stained for T (CD3(+)) and natural killer [NK (CD3(-)CD56(+))] lymphocyte surface antigens. Cells were permeabilized, stained for the intracellular cytokines interleukin (IL)-2 and interferon (IFN)-gamma, and analyzed using flow cytometry. BLK had no effect on the resting concentration of stimulated cytokine-positive T and NK lymphocytes or the amount of cytokine they were producing. Exercise resulted in an increase (P < 0.05) in the concentration of stimulated T and NK lymphocytes producing cytokines in the circulation, but these cells produced less (P < 0.05) cytokine post- compared with preexercise. BLK attenuated (P < 0.05) the elevation in the concentration of lymphocytes producing cytokines during exercise; however, BLK did not affect the amount of IL-2 and IFN-gamma produced. These results suggest that adrenergic stimulation contributes to the exercise-induced increase in the concentration of lymphocytes in the circulation; however, it does not appear to be responsible for the exercise-induced suppression in cytokine production.

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

In a study in mild hypertensives, the impact of mental and physical stress on plasma epinephrine (E), norepinephrine (NE), and on their ratio (NE/E) was evaluated. The effect of two beta-adrenoceptor blocking drugs, atenolol and bopindolol, on plasma catecholamine levels was also examined. Each stressful stimulus significantly increased the NE and E levels compared to rest. The increase was progressive from mental stress, through the handgrip test to the treadmill test. A slight decrease in the NE/E ratio was observed following mental stress and the handgrip test, while this ratio increased during the treadmill test. No significant impact of beta blocking treatment on catecholamine levels was observed under any test condition.

Effects of arotinolol on exercise capacity and humoral factors during exercise in normal subjects

A placebo-controlled, double-blind crossover study was undertaken in 10 normal subjects to examine the effects of arotinolol (10 mg bid), a nonselective beta blocker with alpha-blocking activity, on exercise capacity and hormone levels during exercise after a 2-week treatment period. Maximal oxygen uptake (VO2 max) and blood lactic acid concentration (LA) were measured during progressive exercise testing. An exercise intensity equivalent to 4 mmol/l of LA was used for the constant workload exercise test. Humoral factors were measured after 20 minutes of constant workload exercise. The administration of arotinolol significantly decreased systolic blood pressure and heart rate at rest and during exercise, but diastolic blood pressure did not change. No significant difference was found between arotinolol and placebo with regard to VO2 max and maximal workload. Plasma renin activity (PRA), aldosterone (PAC), and norepinephrine (NE) levels at rest and during exercise did not differ between the two treatments. In contrast, plasma epinephrine (EN) levels at rest and during exercise were significantly greater with arotinolol. Atrial natriuretic peptide (ANP) at rest did not differ between the two treatments. However, exercise caused a significant increase in ANP after arotinolol treatment. These findings suggest that arotinolol decreases blood pressure and heart rate without affecting exercise capacity.

Assessment of sympathoneural activity in clinical research

The assessment of autonomic nervous activity is a frequent and challenging goal of clinical research. The diverse current approaches are reviewed. Direct recording from the sympathetic input to muscle has the advantage of excellent time resolution and directness, but gives no information on the sympathetic input to the internal organs. Plasma noradrenaline concentration has limitations of specificity, some of which are overcome by single isotope radiotracer kinetic techniques. Other chemical markers are less satisfactory. End organ responses are generally limited to cardiovascular and cutaneous autonomic assessment, but sophisticated information is obtainable using power spectral analysis of heart rate variability. Assessment of receptor systems, of first and second messengers and radionuclide imaging of adrenergic nerves all give complimentary information. It is likely that a combination of these diverse techniques will advance understanding of the role of the autonomic nervous system in many disease states.

Selective enhancement of the cardiac sympathetic response to exercise by anginal chest pain in humans

Cardiac and whole body [3H]norepinephrine kinetics were used to evaluate the response of overall and cardiac sympathetic activity to supine bicycle exercise in 31 patients with coronary artery disease (CAD) and in nine normal control subjects (group 1). Of the 31 patients with CAD, 20 developed evidence of myocardial ischemia during exercise (group 2), typical angina occurring in 20 of 20 and ischemic ST segment changes in 13 of 20, whereas 11 patients developed no evidence of ischemia (no chest pain or electrocardiographic changes) (group 3). Exercise resulted in increased total and cardiac NE spillover in all groups of patients. Basal cardiac NE spillover was similar in the three groups (group 1, 5 +/- 1 ng/min; group 2, 8 +/- 1 ng/min; group 3, 7 +/- 2 ng/min; p = NS), but during exercise, cardiac NE spillover was greater in patients who developed angina (group 2, 30 +/- 5 ng/min) than in those who did not (group 1, 17 +/- 2 ng/min; group 3, 17 +/- 2 ng/min; p less than 0.05). The increases in total NE spillover were similar in the three groups. Supine bicycle exercise increases cardiac and overall sympathetic tone in normal control subjects and in patients with CAD. The occurrence of angina selectively enhances the cardiac sympathetic response to exercise. In the absence of angina, patients with CAD and control subjects without CAD have similar sympathetic responses to exercise.

Epinephrine potentiation of in vivo stimuli reverses aspirin inhibition of platelet thrombus formation in stenosed canine coronary arteries

In 18 anesthetized dogs with a 70% mechanically produced coronary artery stenosis, blood flow measured with an electromagnetic flowmeter showed cyclical reductions in flow due to periodic acute platelet thrombus formation. These were abolished in eight of nine dogs with 2.5 mg/kg of aspirin given intravenously and in nine of nine dogs with 5 mg/kg of aspirin. However in 14 of 18 dogs the cyclical flow reductions were temporarily renewed with the infusion of epinephrine 0.4 microgram/kg/min. Human platelets inhibited with aspirin can be reactivated with physiologic amounts of epinephrine. We postulate that in patients with atherosclerotic stenotic lesions the use of aspirin to inhibit arterial thrombus formation may be less effective when they have elevated catecholamines.

Is there coronary vasoconstriction after intracoronary beta-adrenergic blockade in patients with coronary artery disease

Vasomotility of normal and stenosed coronary arteries was studied at rest and during supine bicycle exercise in 10 patients with classical exercise-induced angina pectoris receiving 1 mg intracoronary propranolol before the exercise test (propranolol group). Normal and stenotic coronary lumen areas were determined from biplane coronary arteriograms using a computer-assisted system. Measurements were performed at rest, after 1 mg intracoronary propranolol, during supine exercise (89 W for 3.4 minutes) and 5 minutes after 1.6 mg sublingual nitroglycerin administered at the end of the exercise test. The results were compared with previously obtained data on the effect of dynamic exercise on coronary lumen area in 12 patients receiving no medication (control group) and in 6 patients receiving 0.1 mg intracoronary nitroglycerin before the exercise test (nitroglycerin group). In the control group, coronary stenosis area decreased during exercise to 71% of levels at rest (p less than 0.001) whereas normal coronary lumen area increased to 123% of control (p less than 0.01). In the propranolol group both normal (113%, p less than 0.05 versus rest) and stenotic coronary lumen area (122%, p less than 0.05 versus rest) increased during exercise. A similar increase in both normal and stenotic areas was observed during exercise after pretreatment with 0.1 mg intracoronary nitroglycerin (123%, p less than 0.01 and 114%, p = NS versus rest). Sublingual administration of 1.6 mg nitroglycerin at the end of exercise increased coronary stenosis area to 145% (p less than 0.01 versus rest) in the propranolol group and to 115% in the control group (p = NS versus rest). It is concluded that intracoronary administration of propranolol does not potentiate coronary vasoconstriction of the epicardial vessels at rest and during exercise. In contrast, intracoronary propranolol prevents exercise-induced stenosis narrowing either because of reduced myocardial oxygen demand with a lower coronary blood flow resulting in a smaller transstenotic pressure gradient and, thus, a smaller flow-induced fall in stenosis distending pressure; or because of "local" beta-receptor blockade with unopposed distal arteriolar alpha-receptor tone, resulting in a higher poststenotic pressure and, thus, in a greater stenosis distending pressure; or because of a local anesthetic effect of propranolol with a decrease in calcium influx to the coronary smooth musculature.

Variable neurohumoral and hemodynamic responses to exercise in patients with exertional angina: influence of the severity of coronary artery disease

To assess neurohumoral and hemodynamic responses to exercise in patients with exertional angina, we measured plasma norepinephrine (NE) concentrations in 23 patients with exertional angina (with no heart failure) and compared the results with their coronary arteriographic findings. The 23 patients were divided into two groups: 14 cases with multiple vessel disease (MVD) and 9 cases with one-vessel disease. At resting state there were no significant differences between the two groups in levels of NE. At maximal exercise there were no significant differences between the groups in increases of heart rate, blood pressure, and rate-pressure product, but exercise-induced increase of plasma NE (%) was significantly larger in MVD (131.6 +/- 95.4%) (mean +/- SD) than in one-vessel disease (69.0 +/- 45.3%) (p less than 0.01). In conclusion, plasma NE responses to exercise differ between patients with multiple vessel disease and patients with one-vessel disease.

Plasma norepinephrine in exercise-induced ventricular tachycardia

The relation between plasma norepinephrine levels and the occurrence of ventricular tachycardia during exercise testing was prospectively evaluated in 17 patients. Ten patients had reproducible ventricular tachycardia exclusively during exercise or recovery, or both; 7 patients had ventricular tachycardia only during ambulatory electrocardiographic monitoring. The two groups did not differ in age, exercise duration, left ventricular ejection fraction at rest, heart rate throughout the exercise protocol, rest QTc interval, change in QTc interval during exercise, the presence of coronary artery disease or exercise-related myocardial ischemia. Furthermore, there was no difference between groups in plasma norepinephrine levels at rest, peak exercise or in the recovery period. Myocardial ischemia was detectable by thallium perfusion scan in only 2 of the 10 patients with exercise-induced ventricular tachycardia. The 10 patients with exercise-induced ventricular tachycardia underwent repeat exercise testing immediately after maximal intravenous beta-adrenergic blockade with propranolol. Although they had no change in exercise duration, ventricular tachycardia did not occur in 9 of these 10 patients. Plasma norepinephrine levels were significantly decreased compared with levels before beta-adrenergic blockade (p less than 0.0002). Thus, plasma norepinephrine levels do not distinguish patients with reproducible exercise-induced ventricular tachycardia from otherwise comparable patients. Propranolol is highly effective in abolishing this arrhythmia and this effect is associated with decreased norepinephrine levels.

Circulatory response to beta-adrenergic blockade at rest and during exercise

The beta adrenoceptors involved in the regulation of the cardiovascular system include the beta 1 subtype in the heart, coronary arteries and juxtaglomerular cells of kidney, and the beta 2 subtype in skeletal muscle resistance vessels and on terminals of sympathetic nerves. The beta 1 receptors are activated primarily by norepinephrine released from the sympathetic nerves, the beta 2 by circulating epinephrine from the adrenal medulla. The function of these receptors is to adjust the circulation to meet the stresses imposed by gravitational forces including those that occur in changing from supine to standing position, in muscular exercise and during emotional stress. In normal subjects, other systems can compensate if the beta receptors are prevented from functioning. Thus, during beta-adrenergic blockade it is only when the cardiovascular system is taxed severely that deficiencies in its performance become apparent. In patients with cardiovascular diseases, other effects of beta blockers, not yet understood, may also be important.

Effect of selective and nonselective beta-adrenoceptor blockade on thermoregulation during prolonged exercise in heat

The effect of selective and nonselective beta-adrenoceptor blockade on the thermoregulatory responses of 11 physically active, healthy, young adult men was studied during 2-hour block-stepping in heat. The trial consisted of 3 periods of 6 days each during which propranolol (160 mg/day), atenolol (100 mg) or matching placebo was administered in a randomized, double-blind crossover fashion. Propranolol and atenolol induced similar, significant (p less than 0.001) increases in subjective ratings of perceived exertion. The mechanism of this increased fatigue was not evident from the documented alterations in serum electrolyte, blood glucose and blood lactate levels or ventilatory parameters. Propranolol did, however, induce a postexercise delayed serum-potassium reversion. Although rectal and mean skin temperature responses were essentially unaltered by beta-adrenoceptor blockade during block-stepping, an increased total sweat loss was observed with propranolol (p less than 0.01 versus placebo) and to a lesser degree with atenolol (p = not significant versus placebo). This indicates that persons receiving beta-adrenoceptor blockers have an increased need to adhere to a strict fluid-replacement regimen during exercise. This potentially adverse response was minimal with atenolol in contrast to propranolol, and this in turn suggests the use of beta1-selective adrenoceptor blockers during prolonged exercise when adequate fluid replacement is not possible.

Effect of beta blockade on plasma catecholamine levels during psychological and exercise stress

The effect of a single oral dose of 50 mg of metoprolol on plasma catecholamine levels was examined in 11 healthy young men. Subjects were studied during baseline at rest, postural challenge, psychological stressors and graded maximal exercise testing. Metoprolol induced significant increases in plasma norepinephrine (NE) levels across most experimental conditions. Metoprolol did not have a consistent effect on plasma epinephrine levels. Because of wide interindividual variation in drug levels, the NE levels in subjects with high drug levels were compared with the NE levels in subjects who had negligible drug levels. NE levels were higher in subjects with higher drug levels.

Increased left ventricular emptying at maximal exercise after reduction in afterload

Twelve healthy men were studied by M mode echocardiography during exercise to investigate the effect of afterload reduction on left ventricular function at maximal exertion. They performed two maximal exercise bicycle tests 4 hr apart while in the semisupine position and were given 20 mg nifedipine sublingually 30 min before the second test. During the first test end-systolic dimension decreased (p less than .01) and fractional shortening increased from rest to peak exercise (p less than .01), while end-diastolic dimension did not change significantly. At maximal exercise systolic blood pressure was lower after nifedipine than in the preceding control test (202 +/- 10 [mean +/- SD] vs 212 +/- 14 mm Hg; p less than .01), while heart rate was not significantly changed (168 +/- 15 vs 162 +/- 13 beats/min). End-systolic dimension was lower (25.6 +/- 3.3 vs 28.8 +/- 4.2 mm; p less than .01) and fractional shortening higher (50.7 +/- 6.0% vs 45.3 +/- 7.0%; p less than .01) while end-diastolic dimension was unchanged (52.3 +/- 1.9 vs 52.4 +/- 2.6 mm). Our data indicate increased left ventricular emptying at maximal exercise after nifedipine, most probably due to reduction in afterload.