Acute and Chronic Effects of Nitrendipine on Hemodynamics and Myocardial Ischemia in Patients with Combined Angina Pectoris and Hypertension

Abstract

To examine the antianginal and antihypertensive efficacy of nitrendipine, a new calcium channel blocking agent, 25 patients with chronic stable angina pectoris (NYHA I-III) and systemic hypertension underwent cardiac catheterization and treadmill exercise tests. Acute hemodynamic results were obtained before and 2 h after oral administration of 20 mg nitrendipine. They showed a significant decrease in aortic pressure (162.1 +/- 27.4/80.0 +/- 12.1 vs. 134.9 +/- 23.5/74.2 +/- 13.1 mm Hg), pulmonary arterial pressure (25.4 +/- 5.4/11.3 +/- 3.7 vs. 21.9 +/- 5.4/9.9 +/- 3.7 mm Hg), and pulmonary wedge pressure (10.0 +/- 4.4 vs. 6.6 +/- 3.8 mm Hg). Cardiac index (+31%) and stroke volume (+33%) increased markedly, whereas heart rate remained unchanged (66.9 +/- 11.4 vs. 66.8 +/- 10.8 beats/min). Chronic hemodynamic results and exercise tolerance tests were obtained before and 8 weeks after oral nitrendipine therapy. A significant decrease in arterial blood pressure was observed (167 +/- 22/86 +/- 10 vs. 126 +/- 32/76 +/- 19 mm Hg). Exercise tolerance improved concerning test duration (+22%) and total exercise capacity (+37%). Maximal ST-segment depression decreased by 30% (0.2 +/- 0.03 vs. 0.14 +/- 0.02 mV) and subsequently the anginal frequency was reduced from 7.8 +/- 2.1 to 3.8 +/- 1.7 attacks/week (-50%). The maximal rate-pressure product during exercise remained unchanged. Plasma levels of cholesterol, triglycerides, and LDL- and HDL-cholesterol did not show any significant alterations.(ABSTRACT TRUNCATED AT 250 WORDS)