Renal effects of beta-adrenoceptor blockade

Abstract

The beta-adrenoceptor blocking agents are now in wide use for the treatment of a variety of cardiovascular diseases. They are among the most popular forms of pharmacologic therapy for the management of high blood pressure states and are also used commonly for angina pectoris, various cardiac dysrhythmias, and for idiopathic hypertrophic subaortic stenosis. They also have been used for diverse conditions such as migraine and anxiety states and as supportive therapy during withdrawal of alcohol and addictive drugs. Because these agents are so commonly used, it is timely to evaluate their effects on renal function. There appear to be three principal mechanisms by which the beta blockers could influence the kidney: first, by producing hemodynamic changes in the systemic circulation; second, by acting on the renin-angiotensin-aldosterone system; and third, by possibly acting within the kidney to directly influence renal function. A listing of factors that may be involved in mediating beta-blocker effects on the kidney is given in Table 1. The decreases in systemic blood pressure and in cardiac output that are produced by most of these agents, together with the variable increases in total peripheral vascular resistance that can accompany these changes, probably have an effect on renal function. Indeed, on the basis of these changes, we could predict that beta-blocker treatment would produce a reduction in renal function. But perhaps changes in sodium and water balance, and particularly the decreases in activity of the renin aldosterone axis that are normally induced by beta blockade, tend to modify alterations in renal function that might be produced by systemic circulatory factors. The beta-blocking drugs also have an action in the central nervous system and can influence the activity of the peripheral sympathetic nervous system [1]. But, whether beta-blocker-induced changes in sympathetic drive to the kidney can influence renal function is not known. Indeed, the importance of these factors remains somewhat speculative, particularly in view of the varying and contradictory reports from investigators who have studied the effects of the beta blockers on circulatory and renal function. There is also disagreement as to whether these changes in renal function have long-term harmful effects. And in particular, the action of the beta blockers on the intrarenal release of renin, and the possible importance of alterations in activity of the renin-angiotensin system in mediating changes in blood pressure and in circulatory hemodynamics, has become a matter of considerable controversy.