Email this article Propranolol treatment ofeffort angina in patients with arterial hypotension
- Authors: Idrisova EM1, Boschenko AA1, Borovkova NV1, Demochko AV1, Chernov VI1, Karpov RS1
-
Affiliations:
- Issue: Vol 79, No 8 (2004)
- Pages: 32-35
- Section: Editorial
- URL: https://ter-arkhiv.ru/0040-3660/article/view/29882
- ID: 29882
Cite item
Full Text
Abstract
Aim. To compare antianginal efficacy and tolerability of propranolol therapy in patients with stable
angina pectoris and chronic hypotension (Hpts) and normotensive patients with angina of effort (Npts).
Material and methods. A randomized, single-blind, placebo-controlled study was made in 35 Hpts and 38
Npts was made using bicycle exercise tests, echocardiography, stress myocardial scintigraphy with Tl-199.
Results. Acute bicycle exercise tests showed high anti-ischemic activity of propranolol in 86% Hpts
and 65% Npts. Stable antianginal propranolol effect in 57% Hpts was accompanied with a decrease of
myocardial perfusion defect. Secondary resistance or pseudotolerance to an antianginal effect of pro-
pranolol was observed in 43% Hpts in 4-12 weeks (vs 0 of Npts; p < 0,01) as evidenced by Tl-199
stress myocardial scintigraphy. Hpts with secondary resistance and pseudotolerance to propranolol had
lower control hypotension and bradicardia (p < 0,05), more anginal attacks (p < 0,001).
Conclusion. Hpts had rapidly developing secondary resistance and pseudotolerance to propranolol an-
tianginal effect, bad tolerability of the drug.
angina pectoris and chronic hypotension (Hpts) and normotensive patients with angina of effort (Npts).
Material and methods. A randomized, single-blind, placebo-controlled study was made in 35 Hpts and 38
Npts was made using bicycle exercise tests, echocardiography, stress myocardial scintigraphy with Tl-199.
Results. Acute bicycle exercise tests showed high anti-ischemic activity of propranolol in 86% Hpts
and 65% Npts. Stable antianginal propranolol effect in 57% Hpts was accompanied with a decrease of
myocardial perfusion defect. Secondary resistance or pseudotolerance to an antianginal effect of pro-
pranolol was observed in 43% Hpts in 4-12 weeks (vs 0 of Npts; p < 0,01) as evidenced by Tl-199
stress myocardial scintigraphy. Hpts with secondary resistance and pseudotolerance to propranolol had
lower control hypotension and bradicardia (p < 0,05), more anginal attacks (p < 0,001).
Conclusion. Hpts had rapidly developing secondary resistance and pseudotolerance to propranolol an-
tianginal effect, bad tolerability of the drug.
References
- Метелица В. И., Кокурина Е. В., Бочкарева Е. В. и др. Профилактическая фармакология в кардиологии: современное состояние. Кардиология 1996; 2: 4-16.
- Метелица В. И., Оганов Р. Г. (ред.) Профилактическая фармакология в кардиологии. М.: Медицина; 1988.
- Held P. H., Yusuf F. Effects of beta-blockers and calcium channel blockers in acute myocardial infarction. Eur. Heart J. 1993; 14 (suppl. F): 18-25.
- Yusuf F., Petro R., Lewis J. et al. Beta blockade during and after myocardial infarction: An overview of the ranodmized trials. Progr. Cardiovasc. Dis. 1985; 27: 335-371.
- Schneweiss A., Reisin L. Individualized antianginal therapy guided by systemic arterial pressure. Am. J. Cardiol. 1990; 65 (21): 2-5.
- Атаханов Ш. Э., Робертсон Д. Ортостатическая гипотония и вегетативная недостаточность. Кардиология 1995; 3: 41-50.
- Молчанов Н. С. Гипотонические состояния. Л.: Медицина; 1962.
- Davis Т., Delafuente J. Orthostatic hypotension: therapeutic alternatives for geriatric patients. D. I. С. Р. 1989; 23 (10): 750-756.
- Staessen J., Fagart R., Lijnen P. et al. Reference values for am bulatory blood pressure: a meta-analyses. J. Hypertens. 1990; 8 (suppl. 6): S67-S69.
- Шиллер Н., Осипов М. А. Клиническая эхокардиография. M.: Практика; 1993.
- Milecevic G., Vrhovac В., Planic D. A dynamic model for the separation of secondary resistance from tolerance to nitroglycerin infusion. Int. J. Clin. Pharmacol. Ther. Toxicol. 1993; 31: 12-17.
- Boden W. Е., Когг К. S., Bough E. W. Nifedipine-induced hypotension and myocardial ischaemia in refractory angina pectoris. J. A. M. A. 1985; 253: 1131-1135.
- Radice M., Giudici V., Albertini A., Mannarini A. Paradoxical effect of long-term treatment of nifedipine on total ischemic lead in patients with stable angina pectoris. Clin. Cardiol. 1992; 15: 98-102.
- Waters D. Proischemic complications of dihydropyridine calcium channel blockers. Circulation 1992; 42: 1-8.
- Марцевич С. Ю. Рефрактерность к антиангинальным препаратам и развитие толерантности к ним у больных ишемической болезнью сердца. Способы выявления, клиническая значимость, возможность предупреждения: Автореф. дис.д-ра мед. наук. М.; 1994.
- Марцевич С. Ю. Проблема неэффективности длительной терапии антиангинальными препаратами у больных ишемической болезнью сердца. Кардиология 1996; 3: 27-34.
- Elkayam U., Mehra A., Shotan A. et al. Nitrate resistance and tolerance: potential limitations in the treatment of congestive heart failure. Am. J. Cardiol. 1992; 70: 98B-104B.
- Идрисова Е. М., Кладиева Е. А., Боровкова Н. В. и др. Тринитролонг как средство борьбы с толерантностью к нитратам у больных стенокардией на фоне артериальной гипотонии. Клин, фармакол. и тер. 1999; 5: 68-70.
- Метелица В. И., Марцевич С. Ю., Козырева М. П., ОгановР. Г. Толерантность к нитратам: новые данные о механизме развития и возможности коррекции. Кардиология 1998; 12: 56-63.
Supplementary files
