Celiprolol vs Propranolol in Unstable Angina Pectoris: A Double-Blind, Randomized, Parallel-Group Study

Abstract

Celiprolol, a novel beta blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta-1-receptor selectivity and its vasodilator property. In the present report 53 patients with angiographic coronary artery disease but uncompromised left ventricular function and with electrocardiographically documented recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual administration of nitroglycerin were studied. They were randomized for treatment with equipotent doses of either the nonselective beta blocker propranolol (80 mg/day) or the selective beta blocker with beta-2-agonistic property, celiprolol (200 mg/day) during one week. Angina frequency was higher in the propranolol group (P < 0.01), whereas myocardial oxygen demand as estimated by the double product (DP = SBP x HR, systolic blood pressure x heart rate) was equally reduced by the two beta blockers. Forearm blood flow was essentially higher in the celiprolol group (P < 0.001). A stepwise logistic regression analysis showed that the beneficial effects of the beta blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product. The authors conclude that (1) Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. (2) Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product or for systolic blood pressure plus heart rate it performs even eight times better. (3) The similar effects of the two compounds on the double product and the essentially different effects on peripheral flow support the conclusion that celiprolol exerts its beneficial effect to a large extent through its vasodilator property.

Nitric Oxide-Mediated Coronary Flow Regulation in Patients with Coronary Artery Disease: Recent Advances

“…106 Celiprolol was suggested to be potentially useful in patients with angina pectoris and hypertension, complicated by other conditions associated with advanced age, impaired glucose tolerance or diabetes mellitus, peripheral vascular disease, and hyperlipidemia. 107,108 Coronary flow reserve at rest was less in patients with CAD than in control individuals; intracoronary administration of nebivolol increased coronary flow reserve both in the controls and patients; collateral flow index decreased with nebivolol and correlated to changes in heart rate. 109 It appears that intracoronary nebivolol is associated with an increase in coronary flow reserve due to an increase in maximal coronary flow and that the collateral flow index decreases with nebivolol parallel to the reduction in myocardial oxygen consumption.…”