Effects of Nifedipine, Acebutolol, and Their Association on Exercise Tolerance in Patients with Effort Angina

Ponti, C. De; Biase, Anna Maria De; Pirelli, Salvatore; Cataldo, G; Salvadè, P; Lanocita, M; Carù, B

doi:10.1159/000173337

Cited by 9 publications

(2 citation statements)

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“…However, some investigators have found significant improvement in exercise tolerance after nifedipine despite higher heart rate and blood pressure at peak exercise. 20 Moreover, a significant reduction in exercise- induced ST segment depression was observed after intracoronary administration of 0.1 mg of nifedipine, a dose that did not induce peripheral hemodynamic effects. '°In our study the peak-exercise double product was significantly higher after nifedipine in the seven patients in whom the drug improved exercise capacity, suggesting that the mechanism by which nifedipine exerted its salutary action was not secondary to a reduction in myocardial oxygen consumption.…”

Section: Discussionmentioning

confidence: 95%

Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina.

Specchia¹,

Servi²,

Falcone³

et al. 1983

Circulation

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To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p < .001) with less ST segment depression at peak exercise (p < .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II patients nifedipine significantly increased GCVF at rest (p < .05) and at peak exercise (p < .001). Moreover, resting ARCR was decreased (p < .01) and remained significantly lower at peak exercise (p < .01) compared with the prenifedipine values. These data show that nifedipine may increase GCVF and decrease ARCR at rest and at peak exercise in patients with left anterior descending artery disease. Such increase in myocardial oxygen supply seems the most likely mechanism by which nifedipine may improve exercise capacity in patients with stable exertional angina.Circulation 68, No. 5, 1035No. 5, -1043No. 5, , 1983. THE BENEFICIAL EFFECTS of nifedipine, a calcium-channel blocker, in the medical management of angina at rest have been well established, particularly in those patients in whom coronary spasm plays a major role in the pathogenesis of myocardial ischemia.'-3 Several studies have also shown that nifedipine provides substantial benefits to patients with classic exercise-induced angina pectoris. Such salutary action has been ascribed to the reduction in myocardial oxygen consumption that is a result of decreased systemic vascular resistance.9 However, some investigators have demonstrated that intracoronary infusion of nifedipine has the same antianginal efficacy as intravenous administration, despite the absence of significant peripheral hemodynamic effects. '0 Moreover, a druginduced increase in resting myocardial blood flow distal to significant coronary obstructions has been shown in patients with coronary artery disease, suggesting that a direct increase in myocardial oxygen supply could represent a potential alternative mechanism by which nifedipine may exert its antianginal effect.1'The present study was designed to determine whether the increase in coronary flow induced by nifedipine could be of benefit in patients with exertional angina. We examined a homogeneous population of patients with stable exercise-induced angina and left anterior descending artery disease. Great

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Section: Discussionmentioning

confidence: 95%

Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina.

Specchia¹,

Servi²,

Falcone³

et al. 1983

Circulation

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“…The Italian group headed by DePonti [71] found mixed results in their study of diltiazem and acebutolol or propranolol. Patients exercised longer when given the combination, but more patients on the combination stopped exercising earlier because of fatigue, as compared to patients taking either of the single drugs.…”

Section: Chronic Stable Anginamentioning

confidence: 99%

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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Calcium-channel antagonists and beta-adrenergic blocking agents have become important modalities in the cardiovascular therapeutic armamentarium. These drugs are often administered as monotherapy to a wide range of cardiological patients with angina pectoris, hypertension, arrhythmias, congestive heart failure, and other diseases. Since within each class these drugs exhibit pharmacologic differences, it follows that their effectiveness varies in different disease states and that they exhibit a wide variety of side effects. In an attempt to optimize therapy, the individual drugs from these two classes can be combined; and the efficaciousness and side-effect profile of various combinations between calcium-channel antagonists and beta blockers are discussed in this review. Recommendations as to which patients may benefit from a combination and as to which patients may be harmed by the combination therapy will be made. Very few studies have compared the safety and efficacy of a single agent with the combination and with placebo in a controlled randomized fashion. To determine which therapy is superior and to determine which combination one should recommend under what circumstances, such placebo-controlled, randomized trials are a necessity, and will hopefully be performed although the complexity is enormous.

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Performance of the Exercise Test

Harris

White

Exercise Stress Testing for Primary Care and Sports Medicine

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Effects of Nifedipine, Acebutolol, and Their Association on Exercise Tolerance in Patients with Effort Angina

Cited by 9 publications

References 1 publication

Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina.

Effects of nifedipine on coronary hemodynamic findings during exercise in patients with stable exertional angina.

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Performance of the Exercise Test

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