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A proischaemic action of nisoldipine: relationship to a decrease in perfusion pressure and comparison to dipyridamole

D Baumgart¹, T Ehring, G Heusch

¹Department of Pathophysiology, University of Essen, Germany.

Cardiovascular Research

|July 1, 1993

Summary

Nisoldipine and dipyridamole can worsen ischemia in patients with stable angina by reducing blood flow to the heart muscle. However, nisoldipine does not aggravate ischemia if blood pressure is maintained.

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Area of Science:

Cardiology
Pharmacology

Background:

Calcium antagonists like nisoldipine are used to treat angina.
Recent reports suggest nisoldipine may paradoxically worsen ischemia in some patients.

Purpose of the Study:

To investigate the mechanisms behind the pro-ischemic effect of nisoldipine.
To compare the effects of nisoldipine and dipyridamole on myocardial ischemia.

Main Methods:

Anesthetized dogs with induced coronary artery stenosis were studied.
Hemodynamic variables, regional myocardial blood flow, and wall thickening were measured.
Equihypotensive doses of intravenous nisoldipine or dipyridamole were administered.

Main Results:

Both nisoldipine and dipyridamole decreased subendocardial blood flow and contractile function distal to the stenosis.

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These effects were exacerbated when drug-induced hypotension occurred.

Reversing hypotension restored blood flow and function with nisoldipine, but not dipyridamole.

Conclusions:

Nisoldipine and dipyridamole can decrease subendocardial blood flow and contractile function in the presence of coronary stenosis and hypotension.
Nisoldipine does not worsen ischemia when hypotension is prevented.
Dipyridamole causes flow redistribution away from ischemic regions even without hypotension.