Pressor response to beta-blocking drugs

A patient with essential hypertension had a prolonged period of uncontrollable high blood pressure during therapy with the nonspecific beta-blocker nadolol. A subsequent challenge with the beta1-blocker atenolol caused a pressor response associated with diminished catecholamine release, impaired catecholamine clearance, loss of baroreflex response, and bradycardia. Beta-blocking drugs can lead to hypertension by causing fluid retention, reversal of catecholamine vasodilatation, or a direct pressor effect.