Comparison of the Immediate Effects of Two Beta-Blocking Drugs: A Nonselective and a Cardioselective with Modest ISA in Exercise-Induced Angina

Abstract

To compare the effects of two beta-blocking drugs: a nonselective (propranolol) and a cardioselective with modest intrinsic sympathomimetic activity (visacor), 24 patients with stable angina pectoris performed a control exercise (without medication) on a bicycle ergometer (increments of 30 W every 3 min), and thereafter were randomized to receive either propranolol (40 mg t.i.d.) or visacor (200 mg once daily) for a 48-hour double-blind trial. The 2 groups on control exercise were similar with regard to their exercise tolerance: 7.6 ± 2.3 versus 7.1 ± 1.4 min (NS) and the behavior of heart rate, systolic, diastolic blood pressure and double product, at rest and during exercise. They exercised on the 2nd day 2 h after the intake of propranolol or visacor. In the 12 patients randomized to propranolol, heart rate, systolic and diastolic pressures, double product were significantly reduced at rest, compared with control exercise: 67 ± 8 versus 81 ± 10 beats/min (p < 0.01), 132 ± 20 versus 146 ± 21 mm Hg (p < 0.02), 80 ± 8 versus 88 ± 10 mm Hg (p < 0.02), 8,828 ± 1,927 versus 11,863 ± 2,138 mm Hg·min-¹ (p < 0.001), respectively. On the contrary, in the 12 patients randomized to visacor, these parameters at rest were less modified and only heart rate was significantly decreased: 71 ± 9 versus 81 ± 11 beats/min (p < 0.05). The onset of ST-segment depression (≧ 1.0 mm) was delayed 14% (p < 0.05) in the propranolol group, and 31 % (p < 0.01) in the visacor group. The peak double product decreased 27% (p < 0.001) in the propranolol group and 17% (p < 0.02) in the visacor group. Both drugs increased exercise duration, but only in the visacor group, the changes were significant (17%, p < 0.02, vs. 5%, NS in propranolol group). In conclusion, visacor seems to be at least as efficient as propranolol in exercise-induced angina.

The Effect of Epanolol on Intra‐arterial Ambulatory Blood Pressure and Baroreceptor Heart Rate Reflex in Essential Hypertension

“…(1985) reported reduction of both blood pressure and heart rate with epanolol treatment in 19 hypertensive subjects although the changes seen with epanolol were much smaller than changes seen in the same subjects after atenolol. Epanolol had no effect on resting heart rate or blood pressure in normotensive subjects with ischaemic heart disease (Berkenboom et al 1987), but produced a slight fall in systolic pressure (from 178 to 166 mmHg) on maximal exercise.…”

Beta‐adrenoceptor partial agonists: a renaissance in cardiovascular therapy?

“…In particular nocturnal ischaemia with pindolol is more prolonged, possibly associated with the higher resting heart rate. However, epanolol possesses a similar degree of PAA to pindolol yet is probably as effective as propranolol or atenolol (Berkenboom et al, 1987;Chambers et al, 1987). 12adrenoceptor stimulation in the heart and peripheral vessels by pindolol could explain the different responses, but, arterial vasodilatation may be desirable in angina to reduce myocardial work (Challenor et al, 1989).…”

A Comparison of Epanolol and Nifedipine in Stable Angina Patients: Results of a Multicentre Trial

“…Epanolol is a pi-adrenoceptor partial ago nist [2], At low levels of sympathetic activity (for example, rest, light exercise) its agonist activity is sufficient to produce minimal changes in resting haemodynamics [3], while at higher levels of sympathetic activity (for example, moderate to strenuous exercise) its antagonist effect reduces peak exercise heart rate [4], Such a pharmacological profile makes epanolol of particular interest in the treatment of ischaemic heart disease and its antianginal efficacy has been demonstrated in a number of studies [5][6][7],…”