Wirkung des Imidazolin-Rezeptor-Agonisten Moxonidin auf Hämodynamik, koronare Durchblutung, metabolische Ischämiemarker und neurohumorales System bei Patienten mit essentieller Hypertonie Auswirkungen von Moxonidin auf die koronare Durchblutung

Abstract

Moxonidine is a new centrally active imidazoline-receptor agonist being effectively applied in the treatment of arterial hypertension due to its sympathicolytic potency. This is the first investigation regarding the effects of moxonidine on coronary and systemic hemodynamics, metabolic markers of ischemia and neurohumoral parameters in patients with essential hypertension (WHO I-II). We studied moxonidine (single dose of 0.4 mg p.o.) in 22 patients with left ventricular (LV) hypertrophy, ST segment depressions during exercise, pectanginal complaints and negative coronarograms. Assessments included arterial blood pressure, cardiac output, pulmonary artery pressure mean (PAPm), pulmonary capillary wedge pressure (PCWP) and coronary sinus flow (CSF) by intravascular Doppler technique. The moxonidine-induced parameter changes 2 hours later were as follows: a decrease in systolic/diastolic pressure by 28/10 mmHg, and in heart rate by 5 bpm, associated with a decline of PAPm by 17% and of PCWP by 26%. LV work was reduced by 26%, MVO2 by 18% and CSF by 16%. Average peak velocity in CS fell by 18% and coronary flow reserve (with adenosine) increased by 12%. CS-O2 saturation rose by 4%, accompanied by an increase in lactate extraction by 17%, a decrease in norepinephrine spillover by 30% and in arterial endotheline by 20%. In conclusion, moxonidine produces clinically relevant sympathicolysis with beneficial effects on hemodynamics, coronary circulation and neurohumoral parameters.

Effects of moxonidine on sympathetic nervous system activity: An update on metabolism, cardio, and other target-organ protection

“…[ 7 ] Through this mechanism, moxonidine produces clinically relevant sympatholysis, with beneficial effects on hemodynamics, coronary circulation, and neurohumoral parameters. [ 8 ] Also, studies indicated that moxonidine has antiarrhythmic reaction,[ 9 ] suppresses the activation of myocardial infarction, and reacts on postmyocardial infarction remodeling. [ 10 ]…”