title: Stereoselective vascular effects of the (R)- and (S)-enantiomers of propranolol and atenolol.
abstract: All beta-adrenergic antagonists have an asymmetric carbon atom, and most commercially available beta-blockers consist of (R)- and (S)-enantiomers in a fixed 1:1-ratio. The drugs are believed to be contraindicated when peripheral vascular disease exists, presumably due to unopposed alpha-adrenergic vasoconstriction. However, little is known about direct vascular effects of beta-blockers or of stereoselective effects on peripheral arteries. Therefore, we investigated the effects on forearm blood flow (FBF) of brachial artery infusions of the (R)- and (S)- enantiomers of propranolol and atenolol (2, 10, and 50 micrograms/min each) and their inhibitory effects on isoprenaline (Iso)-induced vasodilatation by forearm venous occlusion plethysmography in 12 healthy subjects. Only (R)-propranolol caused an increase in FBF (+21%, p < 0.05), whereas (S)-propranolol and (R)- and (S)-atenolol had no direct effect on peripheral arteries. Vasodilatation induced by Iso was abolished by (S)-propranolol and reduced by (R)-propranolol (-56%, p < 0.05) and (S)-atenolol (-68%, p < 0.05), whereas (R)-atenolol had no effect. Our results indicate that the optically pure (R)- and (S)-enantiomers of propranolol and atenolol do not exert direct vasoconstrictive effects. Furthermore, our results confirm that predominantly (S)-enantiomers have beta-adrenoceptor blocking effects, but they also show that neither the non-beta-blocking (R)-enantiomer of propranolol nor the (S)-enantiomer of the beta 1-selective agent atenolol is completely devoid of blocking effects on vascular beta 2-adrenoceptors.
authors.affiliation: Department of Internal Medicine, University Hospital, Zurich, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Stoschitzky
authors.forename: W
authors.initials: W
authors.lastname: Lindner
authors.forename: W
authors.initials: W
authors.lastname: Kiowski
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001262:Atenolol / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008297:Male; D010991:Plethysmography; D011433:Propranolol / Q000494:pharmacology*; D012039:Regional Blood Flow / Q000187:drug effects; D013237:Stereoisomerism; D013329:Structure-Activity Relationship; D014655:Vascular Resistance / Q000187:drug effects; D014661:Vasoconstriction / Q000187:drug effects*; D014664:Vasodilation / Q000187:drug effects*
chemical_list: D001262:Atenolol; D011433:Propranolol