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Abrupt Propranolol Withdrawal

David H. Spodick, MD, DSc
Arch Intern Med. 1977;137(4):543-544. doi:10.1001/archinte.1977.03630160099029.
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To the Editor.—  The report on abrupt propanolol hydrochloride withdrawal by Pantano and Lee that appeared in the August issue of the Archives (136:867-871, 1976) was an interesting and potentially valuable attempt to cast light in an area of great concern. However, the authors have not considered the growing appreciation that the pre-ejection period (PEP) should not be corrected for heart rate, particularly for changes in the same individual. Atrial pacing, for example, within reasonable rate ranges, does not affect the PEP (the differences in resting individuals are probably due to differences in "sympathetic tone").If the PEP is recalculated from the "PEPI" given in the authors' Table 1, using the customary 0.4 × heart rate "correction factor," it can be seen that the mean PEP for the baseline days was 99 msec. During the two propanol days for which figures are given, the PEP rises to 106 msec on


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