Comparison of propranolol,metoprolol, and acebutolol on insulin-induced hypoglycaemia.

Metoprolol and acebutolol, two supposedly cardio-selective beta-adrenergic recptor blocking agents, were tested in healthy volunteers against propranolol, a non-selective drug, for their effect on blood glucose levels during insulin-induced hypoglycaemia. There was not significant difference between propranolol and metoprolol, which both potentiated the initial hypoglycaemic action of the insulin and delayed the return to normoglycaemia. Acebutolol, even though potentiating the initial hypoglycaemia, did not possess a significant delaying effect. A similar trial should be undertaken in diabetics to determine with certainty the safety of such drugs in diabetes mellitus.     

Effects of propranolol and metoprolol on the peripheral circulation.

The effects of single doses of propranolol and metoprolol on skin temperature and skin and muscle blood flow were compared in 10 normal subjects and four patients with essential hypertension. In normal subjects the mean skin temperature fell by 1.30 +/- 0.62 degrees C 90 minutes after 80 mg propranolol and 0.15 +/- 0.05 degrees C after 100 mg metoprolol. Skin blood flow and resting muscle blood flow were not affected by metoprolol but fell significantly after propranolol. Both drugs reduced post-exercise muscle hyperaemia, propranolol by more than metoprolol. Similar changes were seen in the hypertensive patients. Propranolol should be used with care in patients with known vascular disease.     

Changes in plasma concentrations of acebutolol,propranolol and indomethacin during physical exercise

Following oral administration of d-propranolol, acebutolol and indomethacin to five healthy volunteers, plasma concentrations of each drug were measured in each subject before and at the end of three 5-minute periods on a bicycle ergometer. During the 15 exercise periods, mean plasma levels of d-propranolol rose by 16.4±12.0% (p<0.01), of acebutolol by 9.8±6.0% (p<0.01) and levels of indomethacin fell by 0.8±4.3%. Since exercise can change plasma drug levels, it may be necessary to take samples while exercise is being performed in order to define more precisely the relationship between the plasma concentration of a drug and its effect during exercise.     

Enantioselective inhibitory effect of nicardipine on the hepatic clearance of propranolol in man

The influence of a single oral dose of 30 mg nicardipine on the pharmacokinetics of (R)- and (S)-propranolol, given orally as rac-propranolol 80 mg, was studied in 12 healthy volunteers. The plasma concentrations were higher for the (S)-enantiomer than for the (R)-enantiomer. The Cl_o and the Cl′_intr of (S)-propranolol were significantly lower than the Cl_o and Cl′_intr of (R)-propranolol. The unbound fraction of (R)-propranolol was significantly higher than that of (S)-propranolol. Coadministration of nicardipine significantly increased the AUC and C_max and significantly decreased the Cl_o and Cl′_intr for unbound drug of (R)- and (S)-propranolol. These changes were more important for (R)- than for (S)-propranolol. The protein binding was not altered by nicardipine. The enantioselective effect of nicardipine on the metabolic clearance of propranolol appears to be due to an interaction at the level of the metabolizing enzymes. The effect on blood pressure of rac-propranolol was little affected when nicardipine was coadministered with rac-propranolol, and its bradycardic effect was reduced. © 1994 Wiley-Liss, Inc.     

Effect of propranolol and metoprolol on parathyroid hormone and calcitonin secretions in uraemic patients.

Nine uraemic patients not being treated by dialysis received intravenous propranolol 1 microgram/kg/min for 85 minutes after a priming dose of 1 mg. Fifteen days later, six of them received intravenous metoprolol 1.2 microgram/kg/min after a priming dose of 1.2 mg. Plasma concentrations of parathyroid hormone (PTH) and calcitonin fell significantly after propranolol but not after metoprolol, whereas no change in plasma concentrations of ionised calcium and phosphate occurred with either drug. Heart rate fell similarly with both drugs. The fact that propranolol acutely suppressed PTH and calcitonin secretion in uraemic patients indicates that further studies are warranted to assess the long-term effects of the drug on the secretion of these hormones and on renal osteodystrophy. The contrast between the responses to propranolol and metoprolol supports the concept that PTH and calcitonin secretion is modulated through specific beta 2-receptors.     

Presynaptic inhibitory effects of sotalol, propranolol, and acebutolol on noradrenaline release upon cardiac sympathetic nerve stimulation in anesthetized dogs

Effect of sotalol (STL) was compared with that of (+/-)-propranolol, (+)-propranolol (PPL), and acebutolol (ABL) on noradrenaline (NA) release as measured in coronary sinus (CS) blood during postganglionic stimulation (2 Hz, 30 s) of the left cardiac sympathetic nerves in anesthetized dogs. In control dogs receiving saline, increasing responses of CS-NA concentration, mean CS blood flow, and CS-NA output to repetitive stimulation were relatively stable throughout a given experimental period. Both STL (1,2.5, and 5 mg/kg, i.v.) and (+/-)-PPL (0.5 and 2.5 mg/kg, i.v.) diminished the increased CS-NA concentration by approximately 35 (P less than 0.05) to 60% (P less than 0.01) in a dose-dependent fashion. However, (+)-PPL (0.02-2.5 mg/kg, i.v.) and ABL (0.5-5 mg/kg, i.v.) did not significantly alter the increasing response of CS-NA concentration upon stimulation. STL, (+/-)-PPL, and ABL markedly inhibited the CS blood flow response to stimulation at all doses tested, while (+)-PPL did not significantly diminish the flow response even at the highest dose tested. Consequently, CS-NA output decreased significantly (p less than 0.01) in the presence of STL, (+/-)-PPL, and ABL at all doses tested but not with (+)-PPL at any dose tested. The inhibitory effect of STL and (+/-)-PPL on the increasing response of CS-NA concentration upon stimulation could be related to their beta-blocking effect, which exerts presumably on postulated presynaptic beta-adrenoceptors, as (+)-PPL did not at all diminish the response.(ABSTRACT TRUNCATED AT 250 WORDS)     

Selective antilipolytic effect of bacitracin in the isolated fat cell

Bacitracin, an antibiotic which decreases extracellular degradation, has been used to study peptide hormone degradation $\text{in}\text{vitro}$. The biologic effectiveness of these hormones in the presence of bacitracin has received minimal attention. This study demonstrates inhibition of lipolysis induced by both epinephrine and glucagon in the isolated fat cell (IFC). IFC from epididymal tissue were incubated with 0.5 μM epinephrine and increasing concentrations of bacitracin. Lipolysis was inhibited in a dose-dependent fashion, with a concentration of 5.7 × 10^?4$\text{M}$ bacitracin suppressing lipolysis 50%. Increasing the concentration of epinephrine in the presence of a constant dose of bacitracin overcame the antilipolytic effect. Bacitracin did not increase oxidation of glucose-U-C¹⁴ over basal. In the perifusion system, acute exposure to 5.7 × 10^?4$\text{M}$ bacitracin plus 5 × 10^?9$\text{M}$ glucagon suppressed lipolysis below unstimulated basal levels. Constant bacitracin perifusion produced no change in basal lipolysis but blunted the response to glucagon. ¹²⁵I-glucagon degradation was decreased in the presence of bacitracin. Additional studies with dibutyryl cyclic AMP demonstrated that the antilipolytic effect of bacitracin is exerted at a step beyon the second messenger. Bacitracin exerts a direct antilipolytic effect in isolated fat cells without stimulating glucose uptake and may afford a means of studying antilipolysis in the absence of other insulin-like effects.     

Ambulatory blood pressure during once-daily randomised double-blind administration of atenolol,metoprolol, pindolol,and slow-release propranolol

Intra-arterial ambulatory blood pressure was measured over 24 hours, in 34 patients with newly diagnosed hypertension, both before and after double-blind randomisation to treatment with atenolol (n=9), metoprolol (n=9), pindolol (n=9), or propranolol in its slow-release form (n=7). The dosage of each drug was adjusted at monthly clinic visits until satisfactory control of blood pressure was achieved (140/90 mm Hg or less by cuff) or the maximum dose in the study protocol was reached. A second intra-arterial recording was made after these drugs had been taken once daily at 0800 for three to eight months (mean 5·0±SD 1·4) and was started four hours after the last dose.At the end of the 24-hour recordings blood pressure was significantly lower with all four drugs. The extent to which the drugs reduced blood pressure, however, differed over the 24 hours. Atenolol lowered mean arterial pressure significantly throughout all 24 recorded hours, metoprolol for 12 hours, pindolol for 15 hours, and slow-release propranolol for 22 hours. Neither metoprolol nor pindolol lowered blood pressure during sleep. A significant reduction in heart rate was observed over 20 hours with atenolol, 20 hours with metoprolol, 10 hours with pindolol, and 24 hours with slow-release propranolol. Atenolol, metoprolol, and slow-release propranolol continued to slow the heart rate 24 hours after the last tablet was taken; this effect on heart rate, however, was not sustained throughout the second morning in those patients taking atenolol. Pindolol, the only drug studied that has intrinsic sympathomimetic activity, increased heart rate and did not lower blood pressure during sleep.Atenolol and slow-release propranolol are effective as antihypertensive agents over 24 hours when taken once daily, whereas metoprolol and pindolol may need to be taken more frequently. At times of low sympathetic tone, however, such as during sleep, beta-blockers with intrinsic sympathomimetic activity may raise heart rate and attenuate the fall in blood pressure with treatment.     

Effects of metoprolol and propranolol on glucose tolerance and insulin secretion in diabetes mellitus

Twenty-two hypertensive diabetic patients were admitted to a double-blind, within-patient study, and treated with propranolol 80 mg and metoprolol 100 mg twice daily for 4 weeks according to a cross-over design. Dosages of the two drugs such as to induce comparable cardiovascular effects, did not induce relevant changes of fasting blood glucose levels in patients receiving the oral hypoglycaemic agent glibenclamide (group 1), insulin (group 2) or diet alone (group 3). Glucose tolerance, assessed with a 75 g oral load, was however decreased by propranolol, and not by metoprolol in the glibenclamide-treated group. Glucose-induced insulin secretion was reduced by propranolol and not by metoprolol both in the group treated by diet alone and in the glibenclamide-treated group. It is concluded that cardioselective metoprolol seems to be more suitable than the non-selective propranolol in the treatment of arterial hypertension in diabetic subjects, particularly when sulfonylureas are being used as hypoglycaemic agents.     

Comparison of atenolol and propranolol during insulin-induced hypoglycaemia.

The effects of atenolol, a new beta1-blocking drug, on pulse rate, sweating, and blood glucose levels during insulin-induced hypoglycaemia were studied in a double-blind crossover trial in eight normal subjects using placebo and propranolol as reference agents. The intensity of induced hypoglycaemia was identical for atenolol, propranolol, and placebo. Propranolol prolonged hypoglycaemia, but atenolol did not. Atenolol may therefore be safe for use in patients receiving insulin.     

Comparative studies on the effects of propranolol and acebutolol on blood pressure, serum lipids and lipoproteins in patients with primary hypertension]

A comparative studies on the effect of propranolol and acebutolol on blood pressure, cardiac function, blood serum lipids and lipoproteins were carried out in 48 patients with the primary hypertension double-blind method was applied. Tested drugs were given for 12 weeks. It was found, that both drugs are potent and comparable hypotensive agents normalizing blood pressure in the majority of treated patients. No significant difference in the effect on heart rate and adverse reactions has been noted. Acebutolol did not change lipid metabolism parameters whereas propranolol slightly but statistically significantly increased serum triglycerides.     

Lack of antilipolytic effect of lactate in subcutaneous abdominal adipose tissue during exercise.

The purpose of our study was to evaluate the potential inhibition of adipose tissue mobilization by lactate. Eight male subjects (age, 26. 25 +/- 1.75 yr) in good physical condition (maximal oxygen uptake, 59.87 +/- 2.77 ml. kg-1. min-1; %body fat, 10.15 +/- 0.89%) participated in this study. For each subject, two microdialysis probes were inserted into abdominal subcutaneous tissue. Lactate (16 mM) was perfused via one of the probes while physiological saline only was perfused via the other, both at a flow rate of 2.5 microl/min. In both probes, ethanol was also perfused for adipose tissue blood flow estimation. Dialysates were collected every 10 min during rest (30 min), exercise at 50% maximal oxygen consumption (120 min), and recovery (30 min) for the measurement of glycerol concentration. During exercise, glycerol increased significantly in both probes. However, no differences in glycerol level and ethanol extraction were observed between the lactate and control probes. These findings suggest that lactate does not impair subcutaneous abdominal adipose tissue mobilization during exercise.     

Insulin-like, antilipolytic effect of 12-O-tetradecanoyl phorbol 13-acetate in rat white adipocytes

Previous experimental data documenting an insulin like-effect of 12-O-tetradecanoyl phorbol 13-acetate (TPA), a specific activator of protein kinase C, on glucose transport in adipocytes prompted us to test the hypothesis that TPA might display another insulin-like effect, i.e., antagonize catecholamine-induce lipolysis. TPA (100 nM) led to a decrease of both free fatty acid (41%) and glycerol (58%) release due to 1 microM norepinephrine stimulation in isolated rat adipocytes. TPA also diminished the antilipolytic effect of insulin (5 ng.ml-1) in the presence of 1 microM norepinephrine. Thus, the residual lipolysis with insulin was 25% for free fatty acids and 24% for glycerol release. In the presence of TPA, these values increased to 50% and 45%, respectively. TPA (100 nM) addition to isolated adipocytes induced protein kinase C translocation from the cytosol to the membrane fraction. In control cells, 94.7 +/- 2.9% of the enzyme was found in the cytosol, with the rest found in the membrane. At 10 min after TPA (100 nM) addition, the corresponding value was 43.6 +/- 17.4%, with the rest in the membrane (n = 6, P less than 0.05). These findings indicate that protein kinase C might be involved not only in the insulin action on glucose transport, but also in the mechanism of insulin's antilipolytic action.