Effect of beta-adrenoceptor blockade on atrial natriuretic peptide levels during exercise in angina pectoris.
The effects of epanolol (200 mg once daily) and diltiazem (60 mg three times daily) on the response of atrial natriuretic peptide (ANP) to exercise were investigated in a double-blind placebo-controlled crossover study in 16 patients with angina pectoris. Exercise tolerance as assessed by peak oxygen consumption was similar with all treatments. Peak heart rate (mean and 95% confidence intervals) was lower (P < 0.05) with epanolol (121 (115-130) beats min-1) than with diltiazem (137 (126-148) beats min-1) or placebo (141 (130-152) beats min-1). ANP did not change from resting values with placebo or diltiazem, but rose significantly (P < 0.05) with epanolol from 19.7 (13.0-29.8) pg ml-1 (geometric mean and 95% confidence intervals) during supine rest to 49.6 (33.7-73.0) pg ml-1 at peak exercise. Since ANP release is stimulated by atrial distension, patients with untreated angina may stop exercise before atrial dilatation occurs. With beta-adrenoceptor blockade, a reduction in peak heart rate may necessitate increased chamber volumes to maintain cardiac output, accounting for the rise in ANP.
Riley
M
M
Royal Victoria Hospital, Belfast, N. Ireland.
Elborn
J S
JS
Onuoha
G
G
Erwin
C
C
Shaw
C
C
Khan
M M
MM
Stanford
C F
CF
Nicholls
D P
DP
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000503:physiopathology*; D009320:Atrial Natriuretic Factor / Q000097:blood*; D044482:Benzeneacetamides; D002302:Cardiac Output / Q000187:drug effects; D004110:Diltiazem / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects; D011412:Propanolamines / Q000008:administration & dosage / Q000494:pharmacology
D000319:Adrenergic beta-Antagonists; D044482:Benzeneacetamides; D011412:Propanolamines; D009320:Atrial Natriuretic Factor; C038616:epanolol; D004110:Diltiazem