Assessment of beta blockade with propranolol

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Abstract
Each of 7 subjects received on a weekly basis placebo or 10, 20, 40, 80 or 160 mg propranolol orally 4 times daily. The effect of propranolol on the resting heart rate and the heart rate response to the Valsalva maneuver, tilt, isoproterenol and maximal exercise were measured. Coefficients of determination were calculated from the individual dose-response curves. The resting heart rate and the tachycardiac response to the Valsalva maneuver and tilt cannot be used to estimate .beta.-blockade. Propranolol concentrations correlated well (mean r2 = 0.08) with the isoproterenol dose ratio minus one, but isoproterenol challenges appear clinically inapplicable. Reduction in maximal exercise tachycardia correlated best with propranolol concentrations (mean r2 = 0.89) but, to the extent that exercise could not be performed, there was no reliable way of clinically documenting .beta.-blockade and only the serum concentration of propranolol was available as an indicator of appropriate therapy.