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Antianginal efficacy of carvedilol, a beta-blocking drug with vasodilating activity

1986; Elsevier BV; Volume: 58; Issue: 10 Linguagem: Inglês

10.1016/s0002-9149(86)80010-8

1879-1913

Erwin A. Rodrigues, Avijit Lahiri, Liam O. Hughes, Ravinder S. Kohli, J R Whittington, Edward B. Raftery,

Cardiac electrophysiology and arrhythmias

The efficacy of carvedilol, a new vasodilating β-blocking drug, was evaluated in 20 patients with chronic angina using a single-blind, placebo-controlled protocol. A 2-week placebo phase was followed by therapy with carvedilol, 25 mg twice daily for 2 weeks, after which the dose was doubled. There was then a second placebo phase lasting 2 weeks. Treadmill exercise testing, 24-hour ambulatory electrocardiographic monitoring and drug blood level assays were performed at the end of each phase. Exercise time (mean ± standard error of mean) increased from 7.4 ± 0.5 minutes during placebo to 9.0 ± 0.5 minutes carvedilol, 25 mg twice daily (p <0.001), and to 9.2 ± 0.4 minutes with 50 mg twice daily (p <0.001). Mean time to 1 mm of ST depression in both bipolar leads CM5 and CC5 increased significantly, but peak ST depression did not change. Heart rate at rest was reduced at both dose levels, from 86 ± 4 beats/min during placebo to 70 ± 2 beats/min with 25 mg twice daily (p <0.001) and to 67 ± 3 beats/min with 50 mg twice daily (p <0.001). Systolic blood pressure at rest was significantly reduced at both doses (p <0.05; p <0.01), but blood pressure during exercise was decreased only with the larger dose (p <0.001). The exercise rate-pressure product was 182 ± 9 with placebo and decreased to 153 ± 5 with 25 mg twice daily (p <0.001) and to 138 ± 6 with 50 mg twice daily (p <0.001). The mean hourly heart rate was significantly lower with carvedilol throughout the 24-hour period. The number of episodes of ST-segment depression recorded during ambulatory monitoring was also significantly lower. The drug was well tolerated at both dose levels. These results suggest that carvedilol may be a suitable antianginal agent with a low side effect profile that can be administered in a twice-daily regimen. The decrease in blood pressure during carvedilol therapy suggests that vasodilatation occurs, and this property may confer therapeutic advantages over other β-blocking drugs. The efficacy of carvedilol, a new vasodilating β-blocking drug, was evaluated in 20 patients with chronic angina using a single-blind, placebo-controlled protocol. A 2-week placebo phase was followed by therapy with carvedilol, 25 mg twice daily for 2 weeks, after which the dose was doubled. There was then a second placebo phase lasting 2 weeks. Treadmill exercise testing, 24-hour ambulatory electrocardiographic monitoring and drug blood level assays were performed at the end of each phase. Exercise time (mean ± standard error of mean) increased from 7.4 ± 0.5 minutes during placebo to 9.0 ± 0.5 minutes carvedilol, 25 mg twice daily (p <0.001), and to 9.2 ± 0.4 minutes with 50 mg twice daily (p <0.001). Mean time to 1 mm of ST depression in both bipolar leads CM5 and CC5 increased significantly, but peak ST depression did not change. Heart rate at rest was reduced at both dose levels, from 86 ± 4 beats/min during placebo to 70 ± 2 beats/min with 25 mg twice daily (p <0.001) and to 67 ± 3 beats/min with 50 mg twice daily (p <0.001). Systolic blood pressure at rest was significantly reduced at both doses (p <0.05; p <0.01), but blood pressure during exercise was decreased only with the larger dose (p <0.001). The exercise rate-pressure product was 182 ± 9 with placebo and decreased to 153 ± 5 with 25 mg twice daily (p <0.001) and to 138 ± 6 with 50 mg twice daily (p <0.001). The mean hourly heart rate was significantly lower with carvedilol throughout the 24-hour period. The number of episodes of ST-segment depression recorded during ambulatory monitoring was also significantly lower. The drug was well tolerated at both dose levels. These results suggest that carvedilol may be a suitable antianginal agent with a low side effect profile that can be administered in a twice-daily regimen. The decrease in blood pressure during carvedilol therapy suggests that vasodilatation occurs, and this property may confer therapeutic advantages over other β-blocking drugs.