Related Experiment Videos
Evaluation of a new vasodilating beta-blocking agent, carvedilol, in exertional angina using holter monitoring
Insights
Carvedilol significantly reduces ST depression in patients with exertional angina. This novel beta-blocker with vasodilator action improves antianginal and antiischemic effects over 24 hours.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Exertional angina requires effective antianginal and antiischemic treatments.
- Carvedilol is a novel beta-blocking agent with vasodilator properties.
Purpose of the Study:
- To evaluate the antianginal and antiischemic effects of carvedilol in patients with exertional angina.
- To determine the clinical pharmacologic actions of carvedilol using Holter monitoring.
Main Methods:
- 13 patients with exertional angina underwent 24-hour Holter electrocardiographic monitoring.
- Patients received either placebo or 20 mg carvedilol daily for 1-2 weeks.
- ST-segment depression frequency, magnitude, and duration were analyzed pre- and post-treatment.
Main Results:
- Carvedilol significantly reduced the total frequency of ST depression (p < 0.01).
- Asymptomatic ST depression frequency also decreased significantly (p < 0.01).
- Total magnitude and duration of ST depression showed significant improvement (p < 0.01 and p < 0.05).
Conclusions:
- Carvedilol, at 20 mg daily, effectively treats exertional angina.
- Its 24-hour efficacy suggests a mechanism involving both beta-blockade and vasodilation.
- The drug improved myocardial ischemic episodes without excessive nocturnal heart rate reduction.
Abstract:
Antianginal and antiischemic effects and clinical pharmacologic actions of carvedilol, a novel beta-blocking agent with a vasodilator action, were determined by Holter electrocardiographic monitoring in 13 patients with exertional angina. The patients were observed for 1 week prior to entry into the study, followed by 1 to 2 weeks of treatment with carvedilol. During the observation period the patients received one placebo tablet daily, and during the treatment period one 20 mg tablet of carvedilol daily. Before and after the treatment 24-hour Holter electrocardiographic tracings were obtained. The mean interval of Holter monitoring was 11.2 +/- 4.5 days for the observation and treatment periods, and the mean time of drug administration was 8:25 a.m. (+/- 30 min). The Holter electrocardiographic tracings which were obtained twice in 9 patients during the observation period showed a high degree of reproducibility with respect to the frequency, magnitude and duration of ST-segment depression. The total frequency of ST depression per patient was 4.5 +/- 3.4 events/day pre-drug and 2.1 +/- 2.1 events/day post-drug. There was a significant reduction in total frequency of ST depression post-drug (p less than 0.01). The frequency of asymptomatic ST depression was similarly decreased post-drug (p less than 0.01), and the total magnitude and duration of ST depression were significantly improved post-drug (p less than 0.01 and p less than 0.05, respectively). These effects of carvedilol lasted for 24 hours after administration. Considering that the heart rate was not excessively reduced during the night, and nocturnal myocardial ischemic episodes were not exacerbated, the mode of action of this drug seems to be based on not only a beta-blocking action but also on a vasodilator action. Carvedilol benefits exertional angina when used in a 20 mg s.i.d. regimen.