Related Experiment Videos
Safety and efficacy of esmolol for unstable angina pectoris
D E Wallis1, C Pope, W J Littman
1Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153.
Insights
Esmolol infusion and oral propranolol effectively reduced chest pain episodes in unstable angina patients. Both beta-blockers proved safe and beneficial as adjunct therapy for coronary artery disease management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Unstable angina (UA) is a critical manifestation of coronary artery disease (CAD).
- Beta-adrenergic blockers are a cornerstone in managing UA, but optimal administration routes require further investigation.
Purpose of the Study:
- To compare the efficacy of intravenous esmolol infusion versus oral propranolol in patients with unstable angina.
Main Methods:
- A randomized trial involving 23 UA patients with CAD.
- Patients received either continuous intravenous esmolol or oral propranolol as adjunct therapy.
- Dosing was titrated to achieve a 30% reduction in heart rate and systolic blood pressure double-product.
Main Results:
- Both esmolol and propranolol significantly reduced daily episodes of chest pain compared to baseline.
- The reduction in chest pain was significant in both the esmolol (4.6 to 1.4 episodes) and propranolol (2.6 to 1.0 episodes) groups.
- Cardiac event rates and side effect incidence were similar between groups, with esmolol-related side effects resolving upon discontinuation.
Conclusions:
- Maximally tolerated beta-blockade, whether via intravenous esmolol or oral propranolol, is effective in managing unstable angina.
- Esmolol offers a viable intravenous option for beta-blockade in UA management.
Abstract:
Esmolol is a rapidly metabolized cardioselective beta-adrenergic blocker that provides steady state beta-adrenergic blockade when administered by continuous intravenous infusion. To determine the efficacy of esmolol in the management of unstable angina, 23 patients with known coronary artery disease, who averaged 3.7 +/- 2.7 daily episodes of chest pain at rest, were randomized to receive either a continuous infusion of esmolol (n = 12) or oral propranolol (n = 11), as an adjunct to concomitant antianginal therapy. Patients with systolic blood pressure less than 110 mm Hg, heart rate less than 60 beats/min or known contraindications to beta blockade were excluded. Esmolol was titrated in a step-wise fashion from 2 to 24 mg/min at 5-minute intervals up to a 30% reduction in heart rate and systolic blood pressure double-product. The propranolol dose was increased every 6 hours by 50 to 100% to achieve a similar reduction in heart rate and blood pressure. When compared with their 24-hour baseline periods, both groups achieved a significant reduction in episodes of chest pain, from 4.6 +/- 3.3 to 1.4 +/- 1.5 in the esmolol group (p less than 0.02) and 2.6 +/- 1.4 to 1.0 +/- 1.5 in the propranolol group (p less than 0.02) during the subsequent study period. The cardiac event rate and incidence of drug side effects were similar between the 2 groups; however, side effects seen with esmolol did not require treatment after drug discontinuation. Thus, maximally tolerated beta blockade is an effective therapy for unstable angina.(ABSTRACT TRUNCATED AT 250 WORDS)