title: Heart rate and blood pressure in mitral valve prolapse patients: divergent effects of long-term propranolol therapy and correlations with catecholamines.
abstract: OBJECTIVE
  There is a well known association between mitral valve prolapse (MVP) and low blood pressure (BP), although patients often have high levels of catecholamines and high heart rate (HR). The main objective of our study was to evaluate the effects of long-term adrenergic beta-blockade on these parameters.
  
  
  METHODS
  The study population consisted of 46 patients with MVP and the control group consisted of 20 normal individuals. The study had two phases: in the first phase, patients were free of medications. In the second phase, patients were under treatment with propranolol for 10 to 12 months. The tests were performed in normal individuals and patients in the first phase. Only patients underwent the same tests in the second phase. Measurement of urinary epinephrine and norepinephrine levels, by high performance liquid chromatography, was done. Rest HR was determined by electrocardiogram (ECG), and ambulatory blood pressure and HR were evaluated by 24 hours ambulatory blood pressure monitoring (ABPM) using the auscultatory method.
  
  
  RESULTS
  The levels of epinephrine and norepinephrine were significantly higher in patients than in normal controls and decreased under propranolol. Rest and ambulatory HR were higher in patients and decreased under propranolol. The 24 hours systolic and diastolic BPs were lower in patients, and their values increased under propranolol. Heart rate decreasing and epinephrine levels reduction were positively correlated. No correlation was found between BP increase and catecholamine levels.
  
  
  CONCLUSIONS
  The study results show divergent effects of propranolol on blood pressure, which increased, and on heart rate, that decreased, in patients with MVP. Heart rate decrease was an expected result and depends, namely, on b1 receptors blockade. Increase in BP is an unusual response to adrenergic beta-blockade in normal conditions, and this finding supports the preponderance of b2 receptors on the BP control in patients with MVP.
authors.affiliation: Department of Cardiology, University Hospital of Santa Maria-Faculty of Medicine and CCUL, Lisbon, Portugal. medemilia@hotmail.com
authors.forename: Emilia Pereira
authors.initials: EP
authors.lastname: da Silva
authors.forename: Mónica Mendes
authors.initials: MM
authors.lastname: Pedro
authors.forename: Manuel Gato
authors.initials: MG
authors.lastname: Varela
authors.forename: Nuno
authors.initials: N
authors.lastname: Cortez-Dias
authors.forename: Manuel Pires
authors.initials: MP
authors.lastname: Bicho
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Madeira
authors.forename: Mário G
authors.initials: MG
authors.lastname: Lopes
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D004562:Electrocardiography; D004837:Epinephrine / Q000652:urine; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D009638:Norepinephrine / Q000652:urine; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000889:Anti-Arrhythmia Agents; D011433:Propranolol; D009638:Norepinephrine; D004837:Epinephrine