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Beta-blockers and nitrates in patients with peripheral arterial occlusive disease: long-term findings
J Schweizer1, R Kaulen, A Nierade
12. Medizinische Klinik, Klinikum Dresden-Friedrichstadt.
Insights
Celiprolol and isosorbide dinitrate improved walking distance in peripheral arterial occlusive disease (PAOD) patients. Atenolol worsened walking ability, indicating celiprolol
Area of Science:
- Cardiology
- Pharmacology
- Vascular Medicine
Background:
- Investigated the efficacy of celiprolol, atenolol, and isosorbide dinitrate in 56 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease (PAOD).
- Employed a double-blind, placebo-controlled design over 6 months, assessing walking distance and femoral artery resistance index.
Discussion:
- Atenolol (50 mg/day) significantly reduced walking distance, whereas celiprolol (200 mg/day) and isosorbide dinitrate (80 mg/day) significantly increased it.
- Celiprolol and isosorbide dinitrate improved Doppler flow in the femoral artery, while atenolol increased the resistance index.
- Celiprolol demonstrated vasodilatory properties similar to nitrates, suggesting its utility in managing PAOD alongside ischemic heart disease.
Key Insights:
- Celiprolol and isosorbide dinitrate enhance peripheral arterial blood flow and improve walking capacity in PAOD patients.
- Atenolol may exacerbate symptoms in patients with PAOD and chronic ischemic heart disease.
- Celiprolol exhibits a dual mechanism of action, combining beta-blockade with vasodilatory effects.
Outlook:
- Further research into celiprolol's vasodilatory mechanisms and long-term effects in PAOD is warranted.
- Exploring combination therapies involving celiprolol for complex cardiovascular conditions could be beneficial.
- Investigating patient-specific responses to different antihypertensive agents in PAOD is crucial for personalized treatment.
Methods:
The effect of 6 months' administration of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial occlusive disease (PAOD), double-blind and placebo-controlled, was investigated in 56 patients with chronic ischaemic heart disease and stage IIb PAOD, using as criteria the walking distance and the change in resistance index in the femoral artery. The placebo group consisted of 14 patients with chronic ischaemic heart disease and the same stage of PAOD.
Results:
Patients on 50 mg/day atenolol showed a significant reduction in both pain-free and maximal walking range compared with the controls. In contrast, those taking 200 mg/day celiprolol and those on 80 mg/day isosorbide dinitrate demonstrated significant increases in pain-free and maximal, walking distance compared with the control group. The colour duplex sonographically measured Doppler flow through the femoral artery showed a significant decrease both in the patients taking celiprolol and in those on isosorbide dinitrate, while in those receiving atenolol the resistance index increased significantly.
Conclusions:
The study shows that the beta-adrenoceptor blocker celiprolol also possesses a nitrate-like vasodilatory property and can be used in patients with chronic ischaemic heart disease and impaired peripheral arterial blood flow.