Cardiovascular responses in hypertensive outpatients starting oral propranolol, determined from the brachial pulse upstroke.

Simultaneous measurement of brachial artery pressures, systolic time intervals, initial pulse upstroke gradient and pulse rate was made in 7 adult hypertensive outpatients during rest supine and during bicycle ergometry at 2 different work rates. Measurements were repeated after 1, 6 and 13 wk on oral propranolol 80 mg thrice daily. Rise of pulse upstroke period (reversed after 1 wk) and of inflection time--analogous with preejection period--and fall of inflection, or diastolic, pressure (most marked at 1 wk) can be explained by early reduction of myocardial contractility and pulse rate. The fall of upstroke period, of peak, or systolic, pressure and of pulse rate (more marked after 1 wk) is related to a later 'adaptive' decrease in peripheral resistance. Much useful information can be obtained by such simple examination of the characteristics of the pulse wave in the brachial artery without complex, albeit noninvasive, cardiac investigations.