Protection from morbidity and mortality from first infarcts: the case for beta-blockade

The original concept of alpha and beta sympathetic receptors put forward by Alquist in 1948 suggesting that beta receptors were situated mainly in the heart and alpha receptors peripherally, gave rise to the theory that selective blockade of beta receptors might have the effect of relieving the heart from excessive sympathetic stimulation. This possibility was developed by Black and Stephenson with the birth of the first beta-blocking drugs--pronethalol and propranolol. The importance of such a drug was foreseen by Chamberlain who showed subsequently that propranolol and cervical sympathectomy reduced an exercise tachycardia to the same extent. Pronethalol was not developed for clinical use and propranolol was in any event found to be the more active drug with no demonstrable hazards. Propranolol was marketed for clinical use as 'Inderal' by the Pharmaceuticals Division of Imperial Chemical Industries, UK, where this original work had been done.