Effect of new beta-adrenergic blocking agent, Atenolol (Tenormin), on pain frequency, trinitrin consumption, and exercise ability.

Roy, Priyankur; Day, L. J.; Sowton, Edgar

doi:10.1136/bmj.3.5977.195

Cited by 25 publications

(6 citation statements)

References 5 publications

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“…Theoretically these properties should make atenolol a suitable P-blocker in the treatment of angina pectoris, as indicated in an earlier report on hypertensive patients (3). However, we have found only one paper on the effect of atenolol in long-term treatment of angina (8). In this study atenolol caused a highly significant drop in resting heart rate, exercise heart rate, exercise BP and hence pulse rate/BP product in all patients tested.…”

Section: Discussionmentioning

confidence: 53%

Atenolol in the Treatment of Angina Pectoris

Erikssen

Osvik

Dedichen

1977

Journal of Internal Medicine

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Nineteen men, aged 41–64 years, with stable angina pectoris have completed a random double‐blind study of atenolol, 50 mg b.i.d., atenolol, 100 mg b.i.d., and placebo. Fifteen patients had subjective improvement on atenolol, two were unchanged and two felt worse (because of asthenia/leg fatigue). No significant placebo effect was found. On both atenolol dosages there were highly significant reductions in heart rate at rest and during exercise and in BP. Only the maximal heart rate decreased significantly more on 100 mg atenolol than on 50 mg (p<0.01). Fourteen patients had the same or a better physical performance on the 50 mg b.i.d. regimen than on the 100 mg b.i.d. regimen, although this difference was not significant. Sixteen patients had higher bicycle exercise performance on atenolol than on placebo. Disregarding the three non‐responders, a mean increase of 44% in bicycle performance was found. No serious side‐effects were seen. Most individuals reported an increased feeling of well‐being on atenolol.

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Section: Discussionmentioning

confidence: 53%

Atenolol in the Treatment of Angina Pectoris

Erikssen

Osvik

Dedichen

1977

Journal of Internal Medicine

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“…Exercise tests were carried out in the sitting position on either the Elema-Schonander or Monark exercise bicycles (Roy, Day, and Sowton, 1975).…”

Section: Methodsmentioning

confidence: 99%

Left main stem coronary artery disease. Retrospective review of 26 patients treated surgically or medically.

Day¹,

Vallin²,

Sowton³

1976

Thorax

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Day, L. J., Vallin, H. O., and Sowton, E. (1976). Thorax, 31,[522][523][524][525][526]. Left main stem coronary artery disease. Retrospective review of 26 patients treated surgicaly or medically. The clinical, angiographic, exercise testing, operative, and follow-up data of 26 patients found at angiography to have left main stem coronary artery stenosis, defined as a reduction in the lumen diameter of 50% or more, are reviewed. There was a high incidence of significant proximal stenosis in the branches of the left main stem. No clinical features were found to distinguish patients with left main stem stenosis.All patients were considered for 8aphenous vein bypass grafting, selection being based upon the severity of symptoms, left ventricular function, and suitability of the coronary vessels for grafting. Two patients died within 24 hours of coronary angiography.Nine patients were operated on with no mortality. There has been one late cardiac death during a mean follow-up time of 13 months. All patients were symptomatically improved with a significant (P<0 01) increase in exercise ability postoperatively.Fifteen patients were not operated on. Six of these patients were regarded as operable but surgery was deferred; five have died at a mean time of 712 months. Five of the nine patients regarded as inoperable have died at a mean follow-up time of 14-8 months. The five non-surgical survivors remain symptomatic with no significant change in exercise ability.Recently reported surgical and medical series of patients with left main stem stenosis are reviewed.

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“…Therefore, while beta blockade withdrawal increases the basal heart rate, the rate at which ischaemia develops is reset at a higher level; hence, in some patients atenolol withdrawal produced no deterioration, just as in some patients beta block-281 ade produces no objective benefit. [28][29][30] A second mechanism proposed for withdrawal phenomena is rebound hypersensitivity of cardiac beta receptors to circulating catecholamines.' [1][2][3][4][5][6][7][8][9][10][11][12][13] While hypersensitivity to infused isoprenaline has been seen after propranolol withdrawal in hypertensive'2 and normal" subjects other studies have not confirmed this phenomenon.3132 At the time when rebound hypersensitivity is said to be present after atenolol withdrawall4 no acceleration of the heart rate response with exercise was seen in our patients in group 1 when compared with group 2.…”

Section: Symptomatic Changes (Group 1)mentioning

confidence: 99%

Abrupt withdrawal of atenolol in patients with severe angina. Comparison with the effects of treatment.

Walker¹,

Marshall²,

Farr³

et al. 1985

Heart

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The effects of abrupt withdrawal of atenolol, a long acting cardioselective beta blocker, were studied in 20 patients with severe stable angina pectoris admitted to hospital for coronary arteriography. During the 144 hour postwithdrawal period no serious coronary events occurred. Mean and maximal daily heart rates rose steadily for at least 120 hours. No important arrhythmias were noted on ambulatory electrocardiographic monitoring. Treadmill exercise testing at 120 hours showed little reduction in the times to angina, ST depression, and maximal exercise when compared with those recorded at 24 hours. This deterioration was small when contrasted with the improvements in these indices produced by atenolol treatment in a similar group of patients not admitted to hospital. No change in catecholamine concentrations or acceleration of the heart rate response to exercise occurred after atenolol withdrawal, suggesting that rebound adrenergic stimulation or hypersensitivity was absent or insignificant. Catastrophic coronary events after beta blockade withdrawal (the beta blockade withdrawal syndrome) have occurred almost exclusively in patients taking propranolol, many of whom had unstable angina at the time of withdrawal. This study showed that in patients with stable angina, even when severe, the abrupt withdrawal of atenolol can be expected to result in only minor clinical consequences. The risk to any patient of so called rebound events after withdrawal of beta blockade seems to be related to both the clinical setting and the agent being used.

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Effect of new beta-adrenergic blocking agent, Atenolol (Tenormin), on pain frequency, trinitrin consumption, and exercise ability.

Cited by 25 publications

References 5 publications

Atenolol in the Treatment of Angina Pectoris

Atenolol in the Treatment of Angina Pectoris

Left main stem coronary artery disease. Retrospective review of 26 patients treated surgically or medically.

Abrupt withdrawal of atenolol in patients with severe angina. Comparison with the effects of treatment.

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