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Felodipine in ischaemic heart disease
J V Sheridan1, P Thomas, D J Sheridan
1Department of Cardiology, St. Mary's Hospital, London.
Insights
Felodipine improves exercise capacity and reduces angina episodes in patients with angina pectoris when used with beta-blockers. This calcium channel blocker enhances hemodynamics and is a beneficial addition to standard angina treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Angina pectoris management often involves beta-blockade.
- The role of calcium channel blockers as adjunct therapy requires further investigation.
Purpose of the Study:
- To evaluate the effects of felodipine on hemodynamic parameters and exercise capacity in patients with angina pectoris.
- To assess felodipine's efficacy as an add-on therapy to beta-blockade for angina relief.
Main Methods:
- A study involving 11 patients undergoing cardiac catheterization with beta-blockade.
- A randomized, double-blind study of 14 patients receiving felodipine plus regular beta-blockade.
Main Results:
- Felodipine increased resting heart rate and cardiac index, while decreasing systemic arterial pressure and vascular resistance.
- In patients on beta-blockers, felodipine reduced angina episodes, glyceryl trinitrate use, and increased exercise tolerance by 16%.
- Minor adverse effects were reported; hemodynamic changes were significant without impacting left ventricular contractility indices.
Conclusions:
- Felodipine demonstrates significant systemic vasodilating properties.
- Felodipine is a potentially useful adjunct to beta-blockade for managing angina pectoris.
- The drug improved exercise tolerance and reduced angina symptoms in patients inadequately controlled by beta-blockers alone.
Abstract:
The effects of felodipine on haemodynamics and exercise capacity have been studied in patients with angina pectoris. In a study of 11 patients undergoing cardiac catheterisation with concomitant beta-blockade, oral felodipine (0.075 mg/kg) increased resting heart rate by 16%. During atrial pacing at 100 beats per minute, felodipine decreased mean systemic arterial pressure by 9.6% and systemic vascular resistance by 30% and increased cardiac index by 30%. There was no significant effect on pulmonary haemodynamics or left ventricular end-diastolic pressure and the isovolumic and ejection phase indices of left ventricular contractility were unchanged. In a randomised double-blind study of 14 patients, felodipine, when added to regular beta-blockade, reduced the frequency of episodes of angina and the amount of glyceryl trinitrate consumed. At a similar plasma concentration to that in the above study, felodipine significantly increased exercise tolerance by 16%, without producing a change in the maximal double product. Resting supine heart rate was increased by 7.3% after felodipine administration; supine systolic and diastolic blood pressures were decreased by 13% and 12%, respectively, and erect systolic and diastolic blood pressures by 14% and 10%, respectively. Only minor adverse effects were reported. Because of its systemic vasodilating properties, felodipine should be a useful adjunct to beta-blockade in patients with angina pectoris.