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In certain patients, be used alone or as an initial agent in patients in whom, in the judgment of the physician, treatment should be started with a beta-blocker rather than a diuretic. Propranolol may mask the symptoms of low blood sugar such as increased heart rate, low blood pressure and slow heart rate. Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and the velocity and extent of myocardial contraction. Propranolol exerts ant arrhythmic effects in concentrations producing beta-adrenergic blockade, which appears to be due to a reduction of the elevated outflow pressure gradient which is exacerbated by beta-adrenergic receptor stimulation. Propranolol can, in certain patients, be used alone or as an initial agent in patients in whom, in the judgment of the physician, treatment should be started with a beta-blocker rather than a diuretic. Propranolol should be administered with caution since it may block bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-adrenergic receptors. Care should be taken if adrenaline is given with Propranolol, as this combination can cause severely high blood pressure and slow heart rate. Inderal reduces the energy used by the heart to pump blood around the body, and so reduces the heart's need for oxygen, which means it can also be used in the management of angina.