Short-term behavioral effects of beta-adrenergic medications in men with mild hypertension 0-Adrenergic-inhibiting drugs are widely prescribed for the treatment of hypertension. These drugs have previously been found to influence a variety of psychologic and behavioral functions and have, in some cases, been associated with serious psychiatric side effects. The present study examined psychologic changes associated with 0-blockade therapy. Twenty-six men with mild hypertension (diastolic blood pressure 90 to 110 nun Hg) were randomly assigned to receive either a selective 13,-antagonist (atenolol), a nonselective 13,- and I32-antagonist (propranolol), or a placebo. Both before and after a 2-week period of drug administration, subjects completed a comprehensive assessment of quality of life including measures of mood, memory performance, and side effects. In general, /3 -blocker therapy was associated with relatively few adverse symptoms, particularly when compared with control subjects taking placebo. Reductions in negative emotional states (tension and anger) were observed for subjects receiving atenolol, and the largest improvements in memory performance were observed for subjects receiving propranolol. These results suggest that 0 -blocker therapy is not invariably associated with negative side effects and that some behavioral functions may actually be improved. (CLIN PHARMACOL THER 1988;43:429-35.) James A. Blumenthal, Ph.D., David J. Madden, Ph.D., David S. Krantz, Ph.D., Kathleen C. Light, Ph.D., Daphne C. McKee, Ph.D., Lars-Goran Ekelund, M.D., and Janet Simon, M.P.H. Durham, N.C., Bethesda, Md., and Chapel Hill, N.C. The use of 13-adrenergic-blocking medication for the treatment of mild hypertension is widely accepted as standard medical practice.' Although the decrease in blood pressure and heart rate after 13-blockade is well documented, the effects of 13-blockade on psychologic functioning have received attention only recently.' A number of anecdotal reports have associated 13-blocker therapy with a variety of symptoms including malaise, dysphoria, sleep disturbance, sexual dysfunc- tion, fatigue, and even psychosis. For example, Waal' noted that two of the three patients who committed From the Departments of Psychiatry and Medicine and the Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, the Department of Medical Psychology, Uniformed Services University of the Health Sciences, Bethesda, and the Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill. Supported by a grant from the John D. and Catherine T. MacArthur Foundation, National Institutes of Health grants HL30675, HL31514, and AG04238, and a grant (R07233) from the U.S. Public Health Service. Received for publication May 29, 1987; accepted Sept. 2, 1987. Reprint requests: James A. Blumenthal, Ph.D., Behavioral Physi- ology Laboratory, Box 3926, Duke University Medical Center, Durham, NC 27710. suicide during a 2-year period in a 750-patient hyper- tension clinic had been taking propranolol at one time or another. Ten of the other hypertensive patients re- ceiving propranolol showed signs of clinical depres- sion. Adler' reported decreased mental acuity in five professional people who had "amnesia-like episodes, lack of concentrating ability, difficulty in simple cal- culations, and problems in reading." Estimates of the incidence of negative side effects associated with 13-blockade have exceeded 20%,' and a recent retro- spective, cross-sectional survey of more than 143,000 medicaid recipients found that the use of tricyclic an- tidepressant medication was 50% higher for patients taking P-blockers than for patients taking either hy- dralazine or hypoglycemics.6 Croog et al.' investigated the effects of propranolol, methyldopa, and captopril on a large array of quality- of-life measures, including emotional well-being, neu- ropsychologic functioning, and side effects. Subjects taking propranolol had improvements in some cognitive functions (Trail Making Test Form B) but not on a visual memory task. Although subjects taking propranolol had improved social participation, they also had increased sexual dysfunction and physical symptoms. However, 429