Effect of beta-adrenergic blockade on the circadian rhythm of myocardial ischemia in ambulatory patients with stable angina.
The antiischemic efficacy of the beta 1-selective blocker Bisoprolol at a dose of 10 mg daily was examined in an open pilot study during steady state. ST-segment analysis was obtained during a 14-day treatment period by means of Holter monitoring in 13 patients with documented stable coronary heart disease (CHD) and an average age of 61 years. beta-Blockade produced a 30% reduction in the frequency of ischemic episodes. There were statistically significant reductions in the mean duration of the ischemic episodes from 19 to 12 min, in the sum of ST-segment deviations in all episodes from 1.35 to 1.0 mV, and in the mean number of ischemic episodes per day from 7 to 5. The intensity of the ischemic episodes (mV x s) was reduced by two-thirds. The circadian distribution of ischemic episodes was linked to the circadian rhythm of heart rate (HR), and the antiischemic effect paralleled the negative chronotropic effect of beta-blockade. beta-Blockade had a greater effect on HR during the day (-20 beats/min) than during the night (-10 beats/min). A possible secondary antiarrhythmic effect was the 80% decrease in ventricular extrasystoles.
Prager
G
G
Institute of Cardiology and Clinical Research, Regensburg, Federal Republic of Germany.
Prager
W
W
Hönig
B
B
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000368:Aged; D000553:Ambulatory Care; D000787:Angina Pectoris / Q000503:physiopathology*; D017298:Bisoprolol; D002940:Circadian Rhythm / Q000187:drug effects*; D003327:Coronary Disease / Q000503:physiopathology*; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D011412:Propanolamines / Q000494:pharmacology*
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; D017298:Bisoprolol