Mechanism of action of beta-adrenergic receptor blocking agents in angina pectoris: comparison of action of propranolol with dexpropranolol and practolol.

The effect on exercise tolerance of racemic propranolol has been assessed in eight angina pectoris patients and compared with that of dexpropranolol (the dextro isomer of propranolol), practolol (I.C.I. 50172), and saline. Dexpropranolol has the same local anaesthetic action as propranolol with negligible beta-adrenergic receptor blocking activity, while practolol is a cardio-selective beta-adrenergic blocking agent which does not have local anaesthetic activity.Saline and dexpropranolol had no significant effect on exercise time; racemic propranolol and practolol improved exercise tolerance in six subjects, the response to the two drugs being very similar in individual patients. It was concluded that the beneficial effect of propranolol in angina pectoris results from its action as a beta-adrenergic receptor blocking agent and is not due to its local anaesthetic, or quinidine-like, activity.