Epstein M, Oster J R
J Clin Hypertens. 1985 Mar;1(1):85-99.
The chronic use of propranolol is characterized by 10%-20% decrements of renal plasma flow (RPF) and glomerular filtration rate (GFR). The results of most investigations, however, suggest that the use of nadolol, a long-acting nonselective agent, spares renal function. Similarly, intrinsic sympathomimetic activity (ISA)-positive and cardioselective beta-adrenergic inhibitors and the combined alpha-beta blocker, labetalol, appear to preserve renal hemodynamics. The reason(s) for the apparent disparate effects of various beta blockers is uncertain. The pathophysiological mechanisms are probably multifactorial and relate to either diminished cardiac output or increased renal vascular resistance, or both. It is possible that inhibition of renal vasodilator mechanisms plays a role. The explanation for the relative absence of adverse effects with a given medication probably varies from agent to agent. The clinical implications of beta-blocker-induced renal changes are presently unknown. The alterations are probably not clinically important in patients with normal renal function. In patients with underlying renal insufficiency, there is no reason to avoid the use of beta-adrenoceptor blockers. In some patients, however, one may wish to prescribe those beta blockers that tend to spare RPF and GFR.
长期使用普萘洛尔的特征是肾血浆流量（RPF）和肾小球滤过率（GFR）降低10%-20%。然而，大多数研究结果表明，使用长效非选择性药物纳多洛尔可保留肾功能。同样，具有内在拟交感活性（ISA）的阳性和心脏选择性β-肾上腺素能抑制剂以及联合使用的α-β阻滞剂拉贝洛尔似乎能维持肾血流动力学。各种β受体阻滞剂产生明显不同作用的原因尚不确定。病理生理机制可能是多因素的，与心输出量减少或肾血管阻力增加或两者都有关。肾血管舒张机制的抑制可能起了作用。特定药物相对缺乏不良反应的解释可能因药物而异。β受体阻滞剂引起的肾脏变化的临床意义目前尚不清楚。这些改变在肾功能正常的患者中可能在临床上并不重要。在有潜在肾功能不全的患者中，没有理由避免使用β肾上腺素能受体阻滞剂。然而，在一些患者中，可能希望开那些倾向于保留RPF和GFR的β受体阻滞剂。
