Celiprolol and propranolol for unstable angina pectoris

Abstract

Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product, it did so in eight times as many patients. The similar effects of the two compounds on the double product, and the essentially different effects on peripheral flow, support the theory that celiprolol exerts its beneficial effect to a large extent through its vasodilatory property.

Hazards of (beta) blockade

“…Goodman and Gilman's Pharmacological Basis of Therapeutics recommends that in phaeochromocytoma non-selective β blockers should be used only after adequate (alpha) blockade has been established, to avoid an augmented pressor response to epinephrine; it adds that such effects canalso occur in other situations that involve increased sympathetic activity, such as hypoglycaemic reactions in patients with unstable diabetes or who smoke a lot 2. In the past five years we have shown such pressor effects in prospective randomised double blind trials performed under stressful conditions, such as acute admission to hospital,3 surgery,4 and unstable angina5 (table). The pressor effect is not only reproducible in everyday practice but also greater than Brown suggests.…”

Methods for Improving Clinical Trials

“…In the first study (6) we compared in a parallel-group assessment a vasodilator beta-blocker with a standard beta-blocker. We recently did that in two of our studies of patients with angina pectoris.…”

“…We recently did that in two of our studies of patients with angina pectoris. Data derived from Cleophas et al (6). The former performed significantly better than the latter (persistent angina pectoris at the completion of the trial 17% vs. 33% (p< 0.01).…”