Hazards of (beta) blockade

BMJ 1995;311:1501 (2 December)

Letters

Hazards of (beta) blockade

Pressor effects may be important

EDITOR,--If doctors follow Morris J Brown's recommendation that"until current trials tell us otherwise ... doctors can be encouragedto use either type of ß blocker"¹ then probably many morepatients will be killed than the one described in the case reportto which the final sentence of Brown's editorial ("One dropof timolol down the lacrimal duct can kill") refers.

For more than 10 years non-selective ß blockers have beenabsolutely contraindicated in patients with chronic obstructivepulmonary disease, delayed hypoglycaemia, and severe triglyceridaemia.Goodman and Gilman's Pharmacological Basis of Therapeutics recommendsthat in phaeochromocytoma non-selective ß blockers shouldbe used only after adequate (alpha) blockade has been established,to avoid an augmented pressor response to epinephrine; it addsthat such effects canalso occur in other situations that involveincreased sympathetic activity, such as hypoglycaemic reactionsin patients with unstable diabetes or who smoke . . . [Full text of this article]