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Hypoglycemia-Induced Hypertension in a Diabetic Patient on Metoprolol

ALEXANDER M. M. SHEPHERD, M.D., Ph.D.; MIN-SHUNG LIN, M.D.; and T. KENT KEETON, Ph.D.
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▸Requests for reprints should be addressed to A. M. M. Shepherd, M.D., Ph.D.; Department of Pharmacology, University of Texas Health Science Center; San Antonio, TX 78284.


The University of Texas Health Science Center at San Antonio; San Antonia, Texas


Ann Intern Med. 1981;94(3):357-358. doi:10.7326/0003-4819-94-3-357
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Metoprolol is the only cardioselective (β1) beta-adrenergic antagonist approved for use in the United States. This agent may be preferable to nonselective β-adrenergic blocking agents in stressful situations in which nonselective β1 and β2 blockade would permit unopposed epinephrine induced α-adrenergic vasoconstriction and hypertension (1, 2). Because insulin-induced hypoglycemia may result in elevated levels of epinephrine, metoprolol has been recommended for use in diabetic hypertensive patients in preference to propranolol (3, 4). We report a case of severe hypertension induced by hypoglycemia in a diabetic hypertensive patient receiving metoprolol.

A 60-year-old man was admitted to hospital with a 20-year history

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