Comparative effects of beta adrenergic blocking drugs.

Sowton, Edgar; Gupta, Deepesh; Baker, Ivory

doi:10.1136/thx.30.1.9

Cited by 29 publications

(7 citation statements)

References 13 publications

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“…Several partial agonists were included (oxprenolol, alprenolol, practolol, pindolol). It was concluded that there was no striking difference in effectiveness between drugs with or without partial agonism, except for pindolol where two studies showed that incremental doses of pindolol reduced its anti-anginal efficacy (75,76). Sowton (77) also observed that the full antagonist, atenolol, was more effective than the partial agonist, practolol.…”

Section: Efficacymentioning

confidence: 99%

The Possible Role of the Ancillary Properties of Beta Adrenoceptor Antagonists in the Management of Angina Pectoris

Jd¹

1985

Journal of Internal Medicine

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ABSTRACT. Beta adrenoceptor antagonists are effective in the symptomatic management of angina pectoris. This paper examines critically the possible influence of the ancillary properties of β1 selectivity, partial agonism and membrane‐stabilizing action on the response in anginal patients. The response is categorized according to experimental, pharmacological and clinical end‐points, placing emphasis on the possible errors which may arise from extrapolation from the former to the latter. It is concluded: That selective beta adrenoceptor antagonism confers limited, but tangible advantages over non‐selective antagonists in regard to patients with reversible airways obstruction, and also in the metabolic and haemodynamic response to acute hypoglycaemia. Cardioselectivity does not influence the central haemodynamic response to exercise, but lessens adrenaline‐mediated hypertensive responses to smoking and hypoglycaemia. Non‐selective partial agonists cause less reduction in resting ventricular function, but their effects on cardiac output during exercise are indistinguishable from full antagonists. Membrane stabilizing properties have a marked influence on the tolerability of these agents in terms of unwanted, nonspecific central nervous system symptoms. Unresolved questions relate to the influence of partial agonism on fatigue, metabolic responses, especially blood lipids and glucose, and the possibility of lesser efficacy in angina compared to full antagonists.

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Section: Efficacymentioning

confidence: 99%

The Possible Role of the Ancillary Properties of Beta Adrenoceptor Antagonists in the Management of Angina Pectoris

Jd¹

1985

Journal of Internal Medicine

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“…The ideal way to assess the adequacy of beta blockade is to compare the duration of exercise time before the onset of angina before and after various doses of beta blockers (4, 21,23,33,40). With this technique one also evaluates the effects of therapy on heart rate and blood pressure, which are important determinants of myocardial oxygen demand ( I , 21, and on electrocardiographic ST-segment depression.…”

Section: Exercise Tolerancementioning

confidence: 99%

“…3) and raised blood pressure (23). Many studies have shown that all beta blockers, irrespective of their ancillary pharmacological properties, are equally effective antianginal agents (4,19,21,23,(36)(37)(38)(39)(40)(41)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). This subject has been extensively reviewed (19,21,57,58).…”

Section: What Is the Optimal Dose For Various Beta-blockers?mentioning

confidence: 99%

Assessment of »Optimal» Beta Blockade in Treating Patients with Angina Pectoris

Thadani

1985

Journal of Internal Medicine

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ABSTRACT. Assessment of optimal beta blockade in treating patients with angina pectoris remains a challenge. Reduction in resting heart rate is a poor guide to therapy; the dose response curves are flat and drugs with intrinsic sympathomimetic activity may not lower resting heart rates despite their efficacy. Log plasma concentrations of beta blockers correlate with reduction in exercise tachycardia but not with improvement in exercise tolerance of reduction in myocardial ischaemia. Although useful, reduction in frequency of anginal attacks and nitroglycerin consumption during therapy is a poor guide in assessing optimal beta blockade. The best way to assess optimal therapy is to demonstrate maximum increase in exercise performance in association with reduction in myocardial ischaemia and adequate suppression of exercise‐induced increase in heart rate and blood pressure. This requires repeated exercise testing at multiple work loads after various doses of the drug until there is no further increase in exercise duration or reduction in heart rate. When given in optimal and equipotent doses all beta blockers are equally effective antianginal agents and can be prescribed twice daily.

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“…Other comparative studies, using exercise testing, between oral propranolol, practolol and oxprenolol (50), and oral propranolol, practolol, oxprenolol and alprenolol (47) suggested that the different ancillary pharmacological properties (intrinsic activity and membrane activity) were of little importance in their anti-anginal activity. The view that intrinsic activity might reduce the effectiveness of beta antagonists in angina pectoris by not reducing myocardial work sufficiently (21), may explain these practolol results, especially in view of the more recent findings, in a crossover study, of an 8% increase in exercise tolerance after metoprolol than after propranolol (13), a finding very similar to that reported by Astrom and Val/in (4) in an acute comparison of atenolol and propranolol.…”

Section: Anginamentioning

confidence: 99%