Beta Blockers can Mask not only Hypoglycemia but also Hypotension

Author:

Koracevic Goran1,Micic Sladjana2,Stojanovic Milovan3,Radovanovic Radmila Velickovic4,Pavlovic Milan5,Kostic Tomislav5,Djordjevic Dragan6,Antonijevic Nebojsa7,Koracevic Maja8,Atanaskovic Vesna9,Dakic Sonja9

Affiliation:

1. Department for Cardiovascular Diseases, University Clinical Centre Nis, Nis, Serbia | Faculty of Medicine, University of Nis, Nis, Serbia

2. Faculty of Medicine, University of Nis, Nis, Serbia

3. Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia

4. Faculty of Medicine, University of Nis, Nis, Serbia | Clinic for Nephrology, University Clinical Centre Nis, Nis, Serbia

5. Department for Cardiovascular Diseases, University Clinical Centre Nis, Nis, Serbia | Faculty of Medicine, University of Nis, Nis, Serbia

6. Faculty of Medicine, University of Nis, Nis, Serbia | Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia

7. Clinic for Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia

8. Faculty of Medicine, University of Nis, Nis, Serbia | Innovation Centre, University of Nis, Nis, Serbia

9. Department for Cardiovascular Diseases, University Clinical Centre Nis, Nis, Serbia

Abstract

Background: Beta-adrenergic (β-AR) receptor blockers (BBs) are an essential class of drugs as they have numerous indications. On the other hand, they have numerous unwanted effects that decrease the compliance, adherence, and persistence of this very useful group of drugs. Objective: The paper aims to analyze the possibility that an unnoticed side effect may contribute to a less favorable pharmacologic profile of BBs, e.g., a diminished reaction to a sudden fall in BP. Methods: We searched two medical databases for abstracts and citations (Medline and SCOPUS). Moreover, we searched the internet for drug prescription leaflets (of the individual BBs). Results: Whichever cause of stress is considered, the somatic manifestations of stress will be (partially) masked if a patient takes BB. Stress-induced hypercatecholaminemia acts on β-AR of cardiomyocytes; it increases heart rate and contractility, effects suppressed by BBs. The answers of the organism to hypoglycemia and hypotension share the main mechanisms such as sympathetic nervous system activation and hypercatecholaminemia. Thus, there is a striking analogy: BBs can cover up symptoms of both hypoglycemia (which is widely known) and of hypotension (which is not recognized). It is widely known that BBs can cause hypotension. However, they can also complicate recovery by spoiling the defense mechanisms in hypotension as they interfere with the crucial compensatory reflex to increase blood pressure in hypotension. Conclusion: Beta blockers can cause hypotension, mask it, and make recovery more difficult. This is clinically important and deserves to be more investigated and probably to be stated as a warning.

Publisher

Bentham Science Publishers Ltd.

Subject

Drug Discovery,Pharmacology

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