Brian PrichardBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5441 (Published 11 October 2010) Cite this as: BMJ 2010;341:c5441
- Janet Fricker
In 1964 Brian Prichard published two seminal papers in the BMJ that showed for the first time that β blockers lower blood pressure. In the first, a double blind trial of patients with angina, he noticed that pronethalol produced a small fall in blood pressure (BMJ 1964;1:1227-8, doi:10.1136/bmj.1.5392.1227). This drug was withdrawn in 1963 because it produced tumours in mice. In the second he produced the same effect with propranolol (BMJ 1964;2:725-7, doi:10.1136/bmj.2.5411.725).
At first the medical profession was sceptical, not least because β blockers inhibit cardiac contraction, viewed as an undesirable effect and also reduced cardiac output. Also, the fall in blood pressure was not seen in animals, and the mechanism of action was unclear. Prichard spent the remainder of the 1960s championing the cause, and persuading the drug company ICI to increase the dose of propranolol tablets from 10 mg to 250 mg to allow sufficient dosing of hypertensive patients. Before this patients had to take as many as 40 tablets a day.
Initially it was not fully appreciated that clinicians needed to take time to search for the optimal dose …