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These drugs result in slow and gradual reduction in blood pressure. However, they may be useful in patients with coronary artery disease like angina or after acute myocardial infarction or arrythmias. These drugs reduce the rate of re-infarction. Elderly patients are less responsive to then than the young.These drugs reduce the blood pressure by reducing both force and the rate of the heart contraction of the heart. In patients who are also receiving diuretics, the total peripheral resistance (resistance against which blood flows) is reduced. They also inhibit release of the biogenic substances, rennin and noradrenaline, which may contribute to their anti-hypertensive effect. Dosage: Propranolol is given in a dose of 20 to 40 mg 2 to 4 times daily. It may be increased to double the or up to a maximum of 480 mg if necessary. Its long-acting preparation is given in a dose of 40 to 80 mg once daily. Atenolo is given in a dose of 25 mg once daily and increased to 100 mg once daily. It is presently the most commonly used drug.Acebutolol is given in a dose of 400 mg once daily and increased to 800 mg daily necessary.Meloprolol is given in a dose of 50 mg and increased to 100 to 300 mg daily, if necessary.Oxprenolol is given in a dose of 160 mg daily and increased to 480 mg daily.Bisoprolol is given in a dose of 2.5 to 10 mg once a day.Carvedilol (Carloc) has antioxidant effects also. It is used in a dose of 12.5 to 25 mg once a day. Nebivalol (Nebicard) has as blood vessel dilating effects. It is useful in a dose of 2.5m (in elderly) to 5 mg once a day. Adverse Effects: These drugs may precipitate congestive heart failure in borderline patients. Some elderly patients develop cold hands and feet. The sudden stoppage of these drugs may precipitate an attack of angina or even myocardial infarction and, in rare cases, sudden death.These drugs increase airway resistance and in patients with a history of bronchial asthma, chronic bronchitis, or any other lung disease, may provoke asthmatic attacks. Although the newer cardioselective beta-blockers like metoprolol, atenolol and bisoprolol may be safer for such patients, yet these drugs should be used very cautiously.These drugs prolong the blood sugar-lowering effects of anti-diabetic drugs and mask the symptoms of hypoglycaemia or low blood sugar. This is more pronounced in children during a period of restricted food intake and prolonged exercise. The adverse effects on the central nervous system include fatigue, lethargy, vivid dreams, depression, memory loss, hallucinations, delirium, psychotic reactions, and loss of sensation in the limbs or paraesthesia. Atenolol which does not go to the brain, may be worth a trial in patients who experience such adverse effects with other beta-blockers. Blood lipids may increase by propranolol like drugs.These drugs should be avoided during pregnancy as they may cross the placenta and produce adverse effects of low blood pressure and blood sugar in the newborn. These are also excreted in milk. Beta-blockers may cause sexual dysfunction such as decreased libido (sexual desire) and impotence. Fever, rash, disorders of the muscles and joints, ulcers in the mouth, baldness, and disorders of blood formation are also rare adverse effects of adrenergic beta-blockers. Precautions Propranolol should not be used in patients suffering from respiratory diseases such as asthma, bronchitis, or emphysema. They should be used with caution in patients of diabetes.The prescribed drug should be withdrawn gradually over a period of 1 week as sudden discontinuation may cause a severe heart attack. Doctor should be consulted if the heart rate (pulse rate) is less than 60 beats per minute.If there are any adverse effects on the nervous system, the doctor should be consulted whether switching to atenolol or another drug is advisable.Alpha-Adrenergic Receptor Blockers (Prazosin, Terazosin, Doxazosin)Prazosin is the third or fourth durg in the treatment of hypertension, and preseribed when thiazides and propranolol fail to control the blood pressure. The first dose of this drug produces a curiously powerful effect and should be kept as low as 0.5 mg and preferably be given at bedtime. It blocks sympathetic receptors and has a direct relaxant action on the smooth muscles of the blood vessels. All of these drugs are effective in increasing flow of urine in enlarged of the prostate. A major benefit is that these drugs do not change blood lipids.Dosage: Its usual dose is 2 to 5 mg depending upon the response. Terazosin is usually given in a dose of 1 to 2 mg. It can be increased up to 40 mg, depending on the response.Adverse Effects and Precautions: These can be postural hypotension, dizziness, and palpitation due to increase in the heart rate. Swelling of the feet and impotence may occur. The dose should be kept as low as possible particularly if other diuretics are already being taken when this drug is started. It should be 0.5 mg or even 0.25 mg given at bedtime to avoid a sudden fall in the blood pressure in the elderly. Article Tags: Blood Pressure, These Drugs, Once Daily, Adverse Effects