Raymond P. Ahlquist (1914–1983), James W. Black (1924–2010)
Propranolol ranks with the greatest discoveries in twentieth-century medicine and is the most important heart drug developed since the discovery of digitalis almost 200 years earlier. It was originally developed to relieve the chest pain of angina pectoris but was soon being used for the treatment of heart-rhythm abnormalities, heart attacks, and high blood pressure, in addition to migraine headaches and anxiety.
Raymond Ahlquist, professor of pharmacology at the Medical College of Georgia, planted the seeds of propranol’s discovery in a 1948 publication. Armed with experimental evidence, he postulated that drugs such as epinephrine/adrenaline acted on two related receptor types, which he designated alpha- and beta-adrenergic receptors. The impact of this concept on the biomedical world was a resounding thud until Ahlquist was given the opportunity to write a chapter in a 1954 textbook of pharmacology.
In 1958, Scottish physician-pharmacologist James Black, working at ICI Pharmaceuticals (now AstraZeneca), read Ahlquist’s chapter with keen interest. Black theorized that adrenaline stimulated the beta-adrenergic receptor, leading to an increase in heart rate, which in turn boosted the heart’s requirements for oxygen in excess of the available supply and provoked an anginal attack. If this were the case, slowing the heart rate by blocking the beta-adrenergic receptor could treat angina.
Black’s propranolol (Inderal) rapidly became the world’s best-selling drug, until it was replaced by cimetedine (Tagamet), another Black-developed pharmaceutical. Both discoveries contributed to his 1988 Nobel Prize in Physiology or Medicine. Black (a laboratory physician) is said to have relieved more human suffering than thousands of practicing physicians could have while attending their patients for a lifetime.
Propranolol was the first beta-blocker, a class of drugs that now numbers around twenty. Many of these are preferred to propranolol because of their more specific effects on the heart. Because they reduce heart rate and tremors and relieve anxiety, beta-blockers are sometimes used by entertainers and musicians before performances and auditions to curb stage fright.
SEE ALSO Digitalis (1775), Digitoxin (1875), Nitroglycerin (1879), Epinephrine/Adrenaline (1901), Drug Receptors (1905), Quinidine (1912), Neurotransmitters (1920), Tagamet (1976).
For the past half-century, propranolol and its beta-blocker progeny have been associated with the heart and its disorders.