Nattel S, Rangno R E, Van Loon G
Circulation. 1979 Jun;59(6):1158-64. doi: 10.1161/01.cir.59.6.1158.
Nine patients on chronic treatment with propranolol for essential hypertension for 3 months or longer were studied after abrupt discontinuation of the drug. Each patient demonstrated transient supersensitivity to the chronotropic effects of isoproterenol, beginning 2--6 days (median 4 days) after propranolol withdrawal, lasting for 3--13 days (median 6 days), with the maximum sensitivity on day 6. A significantly lower dose of isoproterenol was necessary to increase heart rate 25 beats/min on day 6 (median dose 1.2 microgram, range 0.3--3.4 microgram) compared with after day 14, when sensitivity had stabilized (median dose 2.3 microgram, range 1.4--7.6 microgram). Six patients had transient symptoms (headache, chest pain, palpitations and sweating) after abrupt propranolol withdrawal, coinciding with supersensitivity to isoproterenol in five. Transient increases in plasma catecholamines and blood pressures and sustained increases in heart rate occurred during the period of isoproterenol supersensitivity in most patients, and may have contributed to symptoms noted. The delayed onset and potentially long duration of beta-adrenergic supersensitivity after abrupt propranolol withdrawal have important clinical implications.
对9例接受普萘洛尔治疗原发性高血压3个月或更长时间的患者在突然停药后进行了研究。每位患者在普萘洛尔停药后2 - 6天（中位时间4天）开始出现对异丙肾上腺素变时作用的短暂超敏反应，持续3 - 13天（中位时间6天），第6天敏感性最高。与第14天敏感性稳定后相比，第6天增加心率25次/分钟所需的异丙肾上腺素剂量显著更低（中位剂量1.2微克，范围0.3 - 3.4微克）（第14天中位剂量2.3微克，范围1.4 - 7.6微克）。6例患者在普萘洛尔突然停药后出现短暂症状（头痛、胸痛、心悸和出汗），其中5例与对异丙肾上腺素的超敏反应同时出现。大多数患者在异丙肾上腺素超敏反应期间出现血浆儿茶酚胺和血压的短暂升高以及心率的持续升高，这可能是所观察到症状的原因。普萘洛尔突然停药后β肾上腺素能超敏反应的延迟发作和可能较长的持续时间具有重要的临床意义。
