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Anti-ischemic effects of celiprolol in patients with exercise-induced angina pectoris
Insights
Celiprolol, a new beta-blocker, significantly improved exercise capacity and reduced myocardial oxygen demand in patients with exercise-induced angina pectoris. It also lowered resting heart rate and blood pressure, enhancing anti-ischemic effects when combined with other medications.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Exercise-induced angina pectoris is a condition characterized by chest pain during physical activity.
- Beta-adrenoreceptor antagonists are commonly used to manage angina.
- Celiprolol is a novel cardioselective beta-adrenoreceptor antagonist.
Purpose of the Study:
- To investigate the anti-ischemic properties of celiprolol.
- To evaluate the efficacy of celiprolol alone and in combination with nitroglycerin and nifedipine in patients with exercise-induced angina pectoris.
Main Methods:
- Open study involving 12 male patients with exercise-induced angina.
- Patients underwent exercise tests on a bicycle ergometer with ECG monitoring.
- Treatments included placebo, nitroglycerin, nifedipine, celiprolol alone, and combinations.
Main Results:
- Celiprolol significantly increased completed work compared to baseline (P < 0.01).
- Celiprolol reduced resting heart rate and myocardial oxygen consumption (double product).
- Combinations of celiprolol with nitroglycerin or nifedipine further improved exercise capacity and reduced blood pressure.
Conclusions:
- Celiprolol demonstrates significant anti-ischemic properties in exercise-induced angina.
- Celiprolol effectively increases work capacity and reduces myocardial oxygen consumption.
- Combination therapy with celiprolol, nitroglycerin, and nifedipine offers enhanced benefits.
Abstract:
The anti-ischemic properties of the new cardioselective beta-adrenoreceptor antagonist celiprolol were investigated in an open study of 12 men (mean age: 58 +/- 6.6 years) with exercise-induced angina pectoris. After all previous anti-anginal medication had been withdrawn for at least 5 half-lives, the patients received placebo, single doses of nitroglycerin buccal spray, sublingual nifedipine, celiprolol alone, and then in association with nitroglycerin and nifedipine. Exercise tests were performed on a bicycle ergometer, with continuous electrocardiographic monitoring. Significantly more work was completed after treatment with celiprolol than at baseline (5280 +/- 2500 versus 4005 +/- 1792 kpm; P less than 0.01). There were further improvements in work completed after the addition of nitroglycerin and nifedipine. Celiprolol reduced the mean resting heart rate from a baseline value of 77.1 beats/min to 69.2 beats/min (P less than 0.01). In contrast, nifedipine induced tachycardia (82.6 beats/min). At rest, all treatments significantly reduced systolic blood pressure, but only nifedipine significantly reduced diastolic blood pressure. At the completion of the exercise protocol, celiprolol reduced the maximal systolic and diastolic blood pressure (P less than 0.05) with further decreases after the addition of nifedipine. The double product was significantly decreased by celiprolol compared with control, nitroglycerin and nifedipine. There was a further improvement of the double product after the addition of nitroglycerin to celiprolol, but the further increase after addition of nifedipine was not significant. In conclusion, it is clear that celiprolol, both alone and in combination with nitroglycerin or nifedipine, can significantly increase the work capacity of patients with exercise-induced angina pectoris and significantly reduce myocardial oxygen consumption.