The anti-ischemic properties of the new cardioselective beta-adrenoreceptor antagonist
celiprolol were investigated in an open study of 12 men (mean age: 58 +/- 6.6 years) with exercise-induced
angina pectoris. After all previous anti-anginal medication had been withdrawn for at least 5 half-lives, the patients received placebo, single doses of
nitroglycerin buccal spray, sublingual
nifedipine,
celiprolol alone, and then in association with
nitroglycerin and
nifedipine. Exercise tests were performed on a bicycle ergometer, with continuous electrocardiographic monitoring. Significantly more work was completed
after treatment with
celiprolol than at baseline (5280 +/- 2500 versus 4005 +/- 1792 kpm; P less than 0.01). There were further improvements in work completed after the addition of
nitroglycerin and
nifedipine.
Celiprolol reduced the mean resting heart rate from a baseline value of 77.1 beats/min to 69.2 beats/min (P less than 0.01). In contrast,
nifedipine induced
tachycardia (82.6 beats/min). At rest, all treatments significantly reduced systolic blood pressure, but only
nifedipine significantly reduced diastolic blood pressure. At the completion of the exercise protocol,
celiprolol reduced the maximal systolic and diastolic blood pressure (P less than 0.05) with further decreases after the addition of
nifedipine. The double product was significantly decreased by
celiprolol compared with control,
nitroglycerin and
nifedipine. There was a further improvement of the double product after the addition of
nitroglycerin to
celiprolol, but the further increase after addition of
nifedipine was not significant. In conclusion, it is clear that
celiprolol, both alone and in combination with
nitroglycerin or
nifedipine, can significantly increase the work capacity of patients with exercise-induced
angina pectoris and significantly reduce myocardial oxygen consumption.