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Celiprolol and propranolol for unstable angina pectoris
T J Cleophas1, M van 't Leven, F H Kauw
1Department of Medicine, Merwede Hospital Sliedrecht-Dordrecht, The Netherlands.
Insights
Celiprolol, a beta-blocker with vasodilatory properties, significantly improved angina frequency more than propranolol in unstable angina patients. Its beneficial effects are linked to improved peripheral blood flow.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Unstable angina pectoris (UAP) management remains challenging.
- Celiprolol, a novel beta-blocker, possesses both beta 1-receptor selectivity and vasodilatory properties.
- These properties suggest potential superiority over traditional beta-blockers like propranolol in UAP.
Purpose of the Study:
- To compare the efficacy of celiprolol versus propranolol in patients with unstable angina.
- To investigate the role of beta-receptor selectivity and vasodilatory effects in UAP treatment.
Main Methods:
- A randomized trial involving 53 patients with UAP and coronary artery disease.
- Patients received either celiprolol (200 mg/day) or propranolol (80 mg/day) for one week.
- Outcomes assessed included angina frequency, myocardial oxygen demand (double product), and forearm blood flow.
Main Results:
- Angina frequency was significantly lower in the celiprolol group compared to the propranolol group (p < 0.01).
- Both drugs equally reduced myocardial oxygen demand (double product).
- Celiprolol significantly increased forearm blood flow (p < 0.001), unlike propranolol.
Conclusions:
- Celiprolol and propranolol both reduce angina frequency in UAP.
- Celiprolol provided superior angina relief, particularly when adjusted for double product reduction.
- The enhanced efficacy of celiprolol is attributed to its vasodilatory properties, impacting peripheral blood flow.
Background:
Celiprolol, a novel beta-blocker, may be more effective than propranolol in unstable angina pectoris because of both its beta 1-receptor selectivity and its vasodilatory property.
Methods:
Fifty-three patients with angiographic coronary artery disease but uncompromised left ventricular function and with recurrent angina pectoris in spite of bed rest, aspirin, and repeated sublingual administration of nitroglycerin were randomized for 1 week of treatment with equipotent doses of either the nonselective beta-blocker propranolol (80 mg/day) or celiprolol (200 mg/day).
Results:
Angina frequency was higher in the propranolol group (p < 0.01), whereas myocardial oxygen demand as estimated by the double product (systolic blood pressure x heart rate) was equally reduced by the two beta-blockers. Forearm blood flow was higher in the celiprolol group (p < 0.001). A stepwise logistic regression analysis showed that the beneficial effects of the beta-blockers were largely dependent on their effect on peripheral flow, in addition to reduction of the double product.
Conclusions:
Both celiprolol and propranolol largely reduce angina pectoris frequency in unstable angina pectoris. Celiprolol contributes to nearly complete relief in three times as many patients as propranolol; after adjustment for double product, it did so in eight times as many patients. The similar effects of the two compounds on the double product, and the essentially different effects on peripheral flow, support the theory that celiprolol exerts its beneficial effect to a large extent through its vasodilatory property.