Felodipine in ischaemic heart disease

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.