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December 1984

Hypertensive Crisis Caused by Hypoglycemia and Propranolol

Author Affiliations

From the Hypertension Division, Mount Sinai School of Medicine, New York.

Arch Intern Med. 1984;144(12):2427-2428. doi:10.1001/archinte.1984.00350220159035

• In a patient with severe hypertension in association with insulin-induced hypoglycemia and prior therapy with propranolol hydrochloride, intravenous 50% dextrose significantly reduced arterial pressure on two occasions. Subsequent reduction of arterial pressure was observed with prazosin hydrochloride, an α-receptor antagonist. The hypertensive episode may have been caused by hypoglycemia stimulating excessive release of epinephrine. In the presence of vascular β2-receptor blockade by propranolol, the hypertensive action of epinephrine was mediated by vascular α-receptors. When β-antagonists must be used in insulin-dependent diabetic patients, β1-selective antagonists appear to be a better choice.

(Arch Intern Med 1984;144:2427-2428)

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