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Safety and efficacy of esmolol for unstable angina pectoris.

Abstract
Esmolol is a rapidly metabolized cardioselective beta-adrenergic blocker that provides steady state beta-adrenergic blockade when administered by continuous intravenous infusion. To determine the efficacy of esmolol in the management of unstable angina, 23 patients with known coronary artery disease, who averaged 3.7 +/- 2.7 daily episodes of chest pain at rest, were randomized to receive either a continuous infusion of esmolol (n = 12) or oral propranolol (n = 11), as an adjunct to concomitant antianginal therapy. Patients with systolic blood pressure less than 110 mm Hg, heart rate less than 60 beats/min or known contraindications to beta blockade were excluded. Esmolol was titrated in a step-wise fashion from 2 to 24 mg/min at 5-minute intervals up to a 30% reduction in heart rate and systolic blood pressure double-product. The propranolol dose was increased every 6 hours by 50 to 100% to achieve a similar reduction in heart rate and blood pressure. When compared with their 24-hour baseline periods, both groups achieved a significant reduction in episodes of chest pain, from 4.6 +/- 3.3 to 1.4 +/- 1.5 in the esmolol group (p less than 0.02) and 2.6 +/- 1.4 to 1.0 +/- 1.5 in the propranolol group (p less than 0.02) during the subsequent study period. The cardiac event rate and incidence of drug side effects were similar between the 2 groups; however, side effects seen with esmolol did not require treatment after drug discontinuation. Thus, maximally tolerated beta blockade is an effective therapy for unstable angina.(ABSTRACT TRUNCATED AT 250 WORDS)
AuthorsD E Wallis, C Pope, W J Littman, P J Scanlon
JournalThe American journal of cardiology (Am J Cardiol) Vol. 62 Issue 16 Pg. 1033-7 (Nov 15 1988) ISSN: 0002-9149 [Print] United States
PMID2903659 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Adrenergic beta-Antagonists
  • Propanolamines
  • Propranolol
  • esmolol
Topics
  • Adrenergic beta-Antagonists (therapeutic use, toxicity)
  • Adult
  • Angina Pectoris (drug therapy)
  • Angina, Unstable (drug therapy)
  • Blood Pressure (drug effects)
  • Female
  • Heart Rate (drug effects)
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Pilot Projects
  • Propanolamines (therapeutic use, toxicity)
  • Propranolol (therapeutic use)
  • Random Allocation

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