Abstract
Study objective:To test reports that beta blockers, particularly lipopbilic forms, impair cognitive function and cause psychiatric disturbances.
Design:Randomized, double-blind, controlled crossover trial with eight-week treatment periods.
Patients:Sequential sample of 43 male veterans, with untreated diastolic blood pressures (DBP) between 90 and 110 mmHg, aged 35–64 years.
Interventions:Propranolol-LA, 80-mg tablets, or atenolol, 50-mg tablets, were given daily, incremented by one tablet at weekly intervals until DBP ≤90 mmHg. Hydrochlorothiazide was added, if necessary.
Main results:Repeated-measures ANOVA was performed on all cognitive tests. Cognitive test performance was not affected by beta blocker therapy in seven of nine tests and was enhanced on Trail Making Test. Performance was impaired only on Digit Cancellation. Neither Speilberger’s State Trait Anxiety Inventory nor the Beck Depression Inventory was affected by either beta blocker.
Conclusions:Atenolol or propranolol therapy does not impair cognitive function or contribute significantly to psychiatric side effects.
Similar content being viewed by others
References
Solomon S, Hotchkiss E, Saravay SM, Bayer C, Ramsey P, Blum RS. Impairment of memory function by antihypertensive medication. Arch Gen Psychiat. 1983;40:1109–12.
Lichter P, Richardson S, Wyke MA. Differential effects of atenolol and enalapril on memory during treatment for essential hypertension. Br J Clin Pharmacol. 1986;21:641–5.
Bryan PC, Efiong DO, Stewart-Jones J, Turner P. Propranolol on tests of visual function and central nervous activity. Br J Clin Pharmacol. 1974;1:82–4.
Salem SA, McDevitt DG. Central effects of beta-adrenoreceptor antagonists. Clin Pharmacol Ther. 1982;33:52–7.
Gengo FM, Huntoon L, McHugh W. Lipid-soluble and water-solubleβ-blockers: comparison of the central nervous system depressant effect. Arch Intern Med. 1987;147:39–43.
Cove-Smith JR, Kirk C. CNS-related side-effects with metoprolol and atenolol. Eur J Clin Pharmacol. 1985;28[suppl]:69–72.
Broadhurst AD. The effect of propranolol on human psychomotor performance. Aviat Space Environ Med. 1980;51:176–9.
Landauer A, Pocock DA, Prott FW. Effects of atenolol and propranolol on human performance. Psychopharmacology. 1979;60:211–5.
Mazzucchi A, Mutti A, Poletti A, Ravanetti C, Novarini A, Parma M. Neuropsychological deficits in arterial hypertension. Acta Neurol Scand. 1986;73:619–27.
Wilkie F, Eisdorfer C. Intelligence and blood pressure in the aged. Science. 1971;172:959–62.
Boller F, Vrtunski PB, Mack JL, Kim Y. Neuropsychological correlates of hypertension. Arch Neurol. 1977;34:701–5.
Franceschi M, Tancredi O, Smirne S, Marcinelli A, Canal N. Cognitive processes in hypertension. Hypertension. 1982;4:226–9.
Shapiro AP, Miller R, King HE, Ginchereau E, Fitzgibbon K. Behavioral consequences of mild hypertension. Hypertension. 1982;4:355–60.
Light KC. Slowing of response time in young and middle-aged hypertensive patients. Exp Aging Res. 1975;1:209–27.
Elias MF, Robbins MA, Schultz NR, Streeter DHP, Elias PK. Clinical significance of cognitive performance by hypertensive patients. Hypertension. 1987;9:192–7.
Wallace RB, Lemke JH, McMorris M, Goodenberger F, Kohout JV, Hinrich S. Relationship of free-recall memory to hypertension in the elderly. The Iowa 65+ Rural Health Study. J Chronic Dis. 1985;38:475–81.
Spieth W. Slowness of task performance and cardiovascular disease. In Welford AT, Birren JE, eds. Behavior, aging and the nervous system. Springfield, IL: Charles C Thomas, 1965.
Miller RE, Shapiro A, King HE, Ginchereau EH, Hosult J. Effect of antihypertensive treatment on the behavioral consequences of elevated blood pressure. Hypertension. 1984;6:202–8.
Lezak M. Neuropsychological assessment. New York: Oxford University Press, 1983; 426.
Wechsler D. Wechsler Adult Intelligence Scale Manual. New York: Psychological Corporation, 1955.
Army Individual Test Battery, Manual of Directions and Scoring. War Department, Adjutant General’s Office, 1944.
Rey A. L’examen clinique en psychologie. Paris: Presses Universi Davis de France, 1964.
Benton AL. The Revised Visual Retention Test (4th ed.). New York: Psychological Corporation, 1974.
Osterrieth PA. Le test de copie d’une figure complexe. Arch Psychol. 1944;30:206–356.
Taylor LB. Localization of cerebral lesions by psychological testing. Clin Neurosurg. 1969;16:269–87.
Beck A. The Beck Depression Inventory. Philadelphia: Center for Cognitive Therapy, 1978.
Spielberger CD, Gorsuch RL, Lushene RE. STAI manual. Palo Alto, CA: Consulting Psychologists Press, 1970.
James M, Griffith DNW, Pearson RM, Newbury P. Effect of oxprenolol on stage fright in musicians. Lancet. 1977;ii:952.
Brantigan CO, Brantigan TA, Joseph N. Effects of beta blockers and beta stimulation on stage fright. Am J Med. 1982;72:88–94.
Taggart P, Carruthers M, Sommerville W. Electrocardiogram, plasma catecholamines and lipids, and their modification by oxprenolol when speaking before an audience. Lancet. 1973;ii:341.
Sharaf A, Salem MB, McDevitt DG. Central effects of beta adrenoreceptor antagonists. Clin Pharmacol Ther. 1983;33:52–7.
Lader MH, Tyrer PJ. Central and peripheral effects of propranolol and sotalol in normal human subjects. Br J Pharmacol. 1972;45:557–60.
Schultz NR, Elias MF, Robbins MA, Streeter DHP, Blakeman N. A longitudinal comparison of hypertensives and normotensives on the Wechsler Adult Intelligence Scale: initial findings. J Gerontol. 1986;41:169–75.
Madden DJ, Blumenthal J, Ekelund L, Krantz D, Light K, McKee D. Memory performance by mild hypertensives following betaadrenergic blockade. Psychopharmacology. 1986;89:20–4.
Costa P, Shock NW. New longitudinal data on the question of whether hypertension influences intellectual performance.In Elias MF, Streeter DHP, eds. Hypertension and cognitive processes. Mount Desert, ME: Beech Hill, 1990.
Wood WG, Elias MF, Schultz NR, Pentz CA. Anxiety and depression in young and middle aged hypertensive and normotensive subjects. Exper Aging Res. 1979;5:15–30.
Goldman H, Kleinman K, Snow M, Bidus D, Korol B. Correlation of diastolic blood pressure and signs of cognitive dysfunction in essential hypertension. Dis Nervous Syst. 1974;35:571–2.
Waal HJ. Propranolol-induced depression. Br Med J. 1967;2:50.
Petrie WM, Maffucci RJ, Woosley RL. Propranolol and depression. Am J Psychiat. 1982;139:92–4.
Kalayam B, Shamoian C. Propranolol, psychoneuroendocrine change, and depression. Am J Psychiat. 1982;139:1374–5.
Friedman L. How do the various beta blockers compare in type, frequency and severity of their adverse effects? Circulation. 1983;67(suppl I):89–90.
Heine B. Psychogenesis of hypertension. Proc R Soc Med. 1970;63:1267–70.
Wheatley D, Balter M, Levine J, Lipman R, Bauer ML, Bonato R. Psychiatric aspects of hypertension. Br J Psychiat. 1975;127:327–36.
McNair D. Self-evaluations of antidepressants. Psychopharmacologia. 1974;37:281–302.
Frohlich ED. Beta blockers and mental performance (editorial). Arch Intern Med. 1988;148:777–8.
Gengo FM, Fagan, SC, de Padova A, Miller JK, Kinkel PR. The effect ofβ-blockers on mental performance in older hypertensive patients. Arch Intern Med. 1988;148:779–84.
Machin D, Campbell MJ. Statistical tables for the design of clinical trials. Boston: Blackwell Scientific Publications, 1987.
Author information
Authors and Affiliations
Additional information
Received from the Veterans Administration Medical Center, Portland Division and Oregon Health Sciences University, Portland, Oregon.
Supported by a Veterans Administration Merit Review Grant, Ayerst Laboratories, and Stuart Pharmaceuticals.
Rights and permissions
About this article
Cite this article
Palac, D.M., Cornish, R.D., McDonald, W.J. et al. Cognitive function in hypertensives treated with atenolol or propranolol. J Gen Intern Med 5, 310–318 (1990). https://doi.org/10.1007/BF02600398
Issue Date:
DOI: https://doi.org/10.1007/BF02600398