[The acute hemodynamic effects of the new vasodilating beta blocker carvedilol in comparison with combined administration of nifedipine and propranolol in patients with coronary heart disease].
The acute hemodynamic effects of carvedilol, a new vasodilating betablocker, were assessed in comparison to the response to nifedipine or a combination of nifedipine and propranolol in patients with coronary artery disease. Either 5 mg carvedilol, 2 mg nifedipine or 2 mg nifedipine + 5 mg propranolol (N + P) were administered intravenously in a not randomized study within 30 min to 10 patients for each drug. Carvedilol reduced (comparable to the effect of N + P) the left ventricular afterload with a decrease of AOPm of 12.6%, p less than 0.001 (N + P -11.8%, p less than 0.001) and systemic vascular resistance of 9.1%, p less than 0.02 (N + P -10.0%, p less than 0.01) and no change of cardiac index. Single treatment with nifedipine leads to a reflex increase of heart rate which could not be observed after carvedilol or N + P as a result of the betablocking properties of carvedilol and propranolol. Therefore, the rate-pressure-product at rest was unchanged after nifedipine but decreased significantly after carvedilol (-10.9%, p less than 0.01) and N + P (-12.4%, p less than 0.01). Negative inotropic effects were significantly lower after carvedilol, with a 6.3% (p less than 0.05) decrease of LV dP/dtmax, compared to N + P (-12.0%, p less than 0.01). Since preload, afterload, and heart rate changes were equal in both groups negative inotropic effects can be compared on the base of dP/dtmax changes. The acute hemodynamic effects (vasodilation without reflex tachycardia, negative inotropic effects) of the new vasodilating betablocker carvedilol are comparable to a combined treatment with nifedipine and propranolol in patients with coronary artery disease and well preserved left ventricular global function.
Mauser
M
M
Medizinische Universitätsklinik, Abt. III, Tübingen.
Voelker
W
W
Ickrath
O
O
Hoffmeister
H M
HM
Karsch
K R
KR
D002227:Carbazoles / Q000008:administration & dosage*; D000077261:Carvedilol; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D009543:Nifedipine / Q000008:administration & dosage*; D011412:Propanolamines / Q000008:administration & dosage*; D011433:Propranolol / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*
D002227:Carbazoles; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol; D011433:Propranolol; D009543:Nifedipine
Hämodynamische Akuteffekte des neuen vasodilatierenden Betablockers Carvedilol im Vergleich zur kombinierten Gabe von Nifedipin und Propranolol bei Patienten mit koronarer Herzerkrankung.