beta blockers to control hypertension

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Deepa100

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Do, we are always told do the alpha blockade before beta with pheochromocytoma. Why is this not true with controlling primary hypertension? I mean why don't we use both alpha and beta blockers?
 
Adrenergic receptors found in the periphery are alpha-1 (causing vasoconstriction) and beta-2 (vasodilatatory). Blocking of these beta-2 receptors without alpha blockage will lead to unopposed alpha-1 action, which leads to even further vasoconstriction.
Elevated blood pressure seen in essential hypertension is not due to highly elevated catecholamines. Therefore, even if beta-2 receptors are blocked, there won't be an aggravated alpha-1 activity. Pathophysiology of essential hypertension is thought to be related with Na+ retention. A drug like propranolol will block beta-1 receptors, which will decrease renin synthesis. Decreased renin synthesis will decrease the activity of renin-angiotensin-aldosterone system. Among other effects, decreased aldosterone will cause decreased Na+ absorption from collecting ducts.
 
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