Differential effects of non-specific beta-blockade and calcium antagonism on blood-clotting mechanisms.

The effects of non-selective beta-blockade (timolol, 5 mg twice daily) and calcium antagonism (isradipine, 2.5 mg twice daily) on heart rate, blood pressure, platelet aggregation, fibrinolytic activity, and platelet cyclic adenosine monophosphate content were investigated in 10 patients with mild hypertension in a randomized, placebo-controlled, double-blind study. Each patient served as his or her own control, taking each drug in turn for two weeks. Both drugs lowered blood pressure to the same degree. During timolol treatment, however, platelet aggregation increased whereas isradipine resulted in a shortening of the euglobulin clot lysis time (p less than 0.05), indicating increased fibrinolytic activity. Platelet aggregation and fibrinolytic activity are modified by cyclic adenosine monophosphate. Since beta-adrenoceptors are present on platelets and endothelial cells, the differences in platelet behavior and fibrinolytic activity may reflect a decreased cyclic adenosine monophosphate production caused by non-selective beta-adrenoceptor blockade.