Magnitude and mechanisms of the antihypertensive action of labetalol, including ambulatory assessment

The blood pressure (BP) effect and modes of action of a twice daily regimen of labetalol (mean 450 mg/day) were assessed in ten mild to moderate hypertensives using continuous ambulatory BP monitoring. The reflex control of BP during physiological interventions was examined just prior to the next dose of medication to estimate the residual alpha‐ and beta‐adrenoceptor blockade. Global 24 h BP was reduced by 15/9 mm Hg, and home pressures by 13/11 mm Hg. The predominant antihypertensive effect was noted during the waking hours. During dynamic exercise significant inhibition of the heart rate and blood pressure rise occurred. Coupled with a reduction of the post‐release BP ‘overshoot’ in Valsalva's manoeuvre, the response resembles that seen with beta‐adrenoceptor blockade. A small alpha‐adrenoceptor blocking action was evident in one patient's response to the Valsalva manoeuvre.