Propranolol-Epinephrine Antagonism with Hypertension and Stroke

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Abstract
We wish to call attention to a potentially dangerous adverse reaction to epinephrine used in combination with propranolol: paradoxical hypertension, which in our case below probably resulted in stroke. When cardiovascular homeostasis is impaired by beta-blocking agents, potentially serious reactions to adrenergic agents may result. A 57-year-old white woman was seen in the emergency room with the complaint of "hives." Current medications included propranolol, 60 mg/d (10 mg every 4 hours), prescribed for many years for "palpitations." She had no history of hypertension. At examination, she was in no distress. Her blood pressure was 120/70 mm Hg and her pulse,

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