Celiprolol and the heart

Abstract

The introduction of β-adrenoceptor antagonists was a major advance in the treatment of hypertension and coronary artery disease. However, nonselective β blockade carries distinct circulatory disadvantages, which accounts for the search for an “ideal” β-blocking drug for use in this extensive therapeutic field. It is possible to define the desirable cardiodynamic profile of a β-blocking drug. How far does celiprolol meet this function? What questions should we address in attempting to evaluate the effects of celiprolol on the heart? In contrast to propranolol, in the normal heart, celiprolol does not depress left ventricular pumping function. There is little information on the effects of celiprolol on left ventricular function in the hypertensive patient. However, we now know that most patients with hypertension already have advancing coronary artery disease. It is reasonable, therefore, to examine the effects of celiprolol on left ventricular function in patients with coronary disease because these can not only be used to evaluate the possible efficacy of the drug in patients with angina pectoris, but also to extrapolate to their clinical effectiveness in most patients with hypertension. Celiprolol does not depress left ventricular pumping function at rest or during exercise, in contrast to other β-adrenoceptor antagonists that reduce both heart rate and left ventricular activity. Moreover, celiprolol possesses anti-ischemic properties equivalent to those of atenolol. It does not appear to aggravate the atherogenic profile of the lipids as much as some other cardioselective β-blocking drugs. These hemodynamic and metabolic factors offer supporting evidence for the efficacious use of celiprolol in patients with high blood pressure, even when this is complicated by the presence of coronary artery disease.