Skip to main content
Log in

Comparison of the cardiovascular effects of nifedipine and nicardipine in the presence of atenolol

  • Originals
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Summary

A placebo controlled double blind crossover study was performed in 12 healthy volunteers to compare the cardiovascular effects of single oral doses of nifedipine (5, 10 and 15 mg) and nicardipine (20 and 30 mg) in the presence of atenolol 100 mg. Haemodynamic measurements were made by transthoracic electrical bioimpedance cardiography (TEBC) 2 h following drug administration during passive tilting, graded bicycle exercise (30–150 W), and recovery from exercise.

In the absence of calcium channel blockade, atenolol reduced mean blood pressure, heart rate, and cardiac index, and increased stroke volume, peripheral resistance, pre-ejection period, and ventricular ejection time, particularly during and after exercise. In comparison with atenolol alone, addition of nifedipine or nicardipine reduced peripheral resistance but did not produce significant changes in stroke volume, cardiac output, dZ/dt[max], pre-ejection period (PEP), Ventricular ejection time (VET), PEP/VET, or Heather index at any point in the experiment. Similar reductions in peripheral resistance were produced by nifedipine 10 mg and nicardipine 20 and 30 mg. These apparently equivalent doses of nifedipine and nicardipine had similar effects on stroke volume, cardiac index, PEP/VET and Heather index.

Thus the increases in ventricular performance previously demonstrated in association with nifedipine and nicardipine therapy were not observed in the presence of β-adrenoceptor blockade. Under these conditions no important differences have been observed in the cardiovascular effects of these two calcium channel blockers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Dargie HJ, Lynch PG, Krikler D, Harris L, Krikler S (1981) Nifedipine and propranolol: a beneficial drug interaction. Am J Med 71: 676–682

    Google Scholar 

  2. Tweddle AC, Beattie JM, Murray RG, Hutton I (1981) The combination of nifedipine and atenolol in the management of angina pectoris. Br J Clin Pharmacol 12: 229–233

    Google Scholar 

  3. Leon MB, Rosing DR, Bonow RO, Lipson LC, Epstein SE (1981) Clinical efficacy of verapamil alone and in combination with propranolol in treating patients with chronic stable angina pectoris. Am J Cardiol 48: 131–139

    Google Scholar 

  4. Opie LH, Lee J, White D (1982) Antihypertensive effects of nifedipine combined with cardioselective beta-adrenergic receptor antagonism by atenolol. Am Heart J 104: 606–612

    Google Scholar 

  5. Husted SE, Kraemmer Nielsen H, Christensen CK, Lederballe Pedersen O (1982) Long-term therapy of arterial hypertension with nifedipine given alone or in combination with a beta-adrenoreceptor blocking agent. Eur J Clin Pharmacol 22: 101–103

    Google Scholar 

  6. Lund-Johansen P, Ohm OJ (1976) Haemodynamic long-term effects of beta-receptor-blocking agents in hypertension. A comparison between alprenolol, atenolol, metoprolol, and timolol. Clin Sci Mol Med 51: 481S:483S

  7. Sorkin EM, Clissold SP, Brodgen RN (1985) Nifedipine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in ischaemic heart disease, hypertension, and related cardiovascular disorders. Drugs 30: 182–274

    Google Scholar 

  8. Stanley NN, Thirkettle JL, Varma MPS, Larkin H, Health ID (1988) The efficacy and tolerability of atenolol, nifedipine, and their combination in the management of hypertension. Eur J Clin Pharmacol 34: 543–548

    Google Scholar 

  9. Oesterle SN, Schroeder JS (1982) Calcium-entry blockade, beta-adrenergic blockade and the reflex control of circulation. Circulation 65: 669–670

    Google Scholar 

  10. Visser CA, Koolen JJ, Van Wezel HB, Jonges R, Hoedemaker G, Dunning AJ (1986) Effects of intracoronary nicardipine and nifedipine on left ventricular function and coronary sinus blood flow. Br J Clin Pharmacol 22: 313S-318S

    Google Scholar 

  11. Cody RJ (1987) Use of invasive ergometric exercise to assess the hemodynamic responses to nicardipine. Am J Cardiol 59: 20J-24J

    Google Scholar 

  12. Anastassiades CJ (1980) Nifedipine and beta blocker drugs. Br Med J 281: 1251–1252

    Google Scholar 

  13. Opie LH, White DA (1980) Adverse interaction between nifedipine and β-blockade. Br Med J 281: 1462

    Google Scholar 

  14. Staffurth JS, Emery P (1981) Adverse interaction between nifedipine and beta-blockade. Br Med J 282: 225

    Google Scholar 

  15. Robson RH, Vishwanath MC (1982) Nifedipine and beta blockade as a cause of cardiac failure. Br Med J 284: 104

    Google Scholar 

  16. Rousseau MF, Vincent MF, Cheron P, van den Berge G, Charlier AA, Pouleur H (1985) Effects of nicardipine on coronary blood flow, left ventricular inotropic state and myocardial metabolism in patients with angina pectoris. Br J Clin Pharmacol 20: 147S-157S

    Google Scholar 

  17. Thomas SHL, Molyneux P, Kelly J, Smith SE (1990) The cardiovascular effects of oral nifedipine and nicardipine: a double-blind comparison in healthy volunteers using transthoracic bioimpedance cardiography. Eur J Clin Pharmacol 39: 233–240

    Google Scholar 

  18. Bernstein DP (1986) A new stroke volume equation for thoracic electrical bioimpedance. Theory and rationale. Crit Care Med 14: 904–909

    Google Scholar 

  19. Balasubramanian V, Mathew OP, Behl A, Tewari SC, Hoon RS (1974) Electrical impedance cardiogram in derivation of systolic time intervals. Br Heart J 40: 268–275

    Google Scholar 

  20. Thomas SHL, Smith SE (1990) Systolic time intervals by the impedance method. Accuracy and correlation with left ventricular function. Br J Clin Pharmacol 30: 304P

  21. Heather LW (1969) A comparison of cardiac output values by the impedance cardiograph and dye dilution techniques in cardiac patients. In: Development and evaluation of an impedance cardiographic system to measure cardiac output and other cardiac parameters. Ed WG Kubicek. NASA Report, Contract NAS 9-4500, pp 247–258

  22. Duncan DB (1955) Multiple range and multiple F tests. Biometrics 11: 1–42

    Google Scholar 

  23. Lederballe Pedersen O, Mikkelsen E (1978) Acute and chronic effects of nifedipine in arterial hypertension. Eur J Clin Pharmacol 14: 375–381

    Google Scholar 

  24. Rousseau MF, Veriter C, Detry J-MR, Brasseur L, Pouleur H (1980) Impaired early left ventricular relaxation in coronary artery disease: effects of intracoronary nifedipine. Circulation 62: 764–772

    Google Scholar 

  25. Ludbrook PA, Tiefenbrunn AJ, Reed FR, Sobel BE (1982) Acute hemodynamic response to sublingual nifedipine: Dependance on left ventricular function. Circulation 65: 489–487

    Google Scholar 

  26. Walley TJ, Heagerty AM, Woods KL, Bing RF, Pohl JEF, Barnett DB (1988) Acute inotropic effects of intravenous nifedipine and its vehicle compared with saline: a double blind study of systolic time intervals in normal subjects. Br J Clin Pharmacol 25: 187–193

    Google Scholar 

  27. Gillmer D, Kark P (1980) Pulmonary oedema precipitated by nifedipine. Br Med J 280: 1420–1421

    Google Scholar 

  28. de Buitlier M, Rowland E, Krikler DM (1985) Haemodynamic effects of nifedipine given alone and in combination with atenolol in patients with impaired ventricular function. Am J Cardiol 55: 15E-20E

    Google Scholar 

  29. Stern HC, Mathews JH, Belz GC (1986) Intrinsic and reflex actions of verapamil and nifedipine: assessment in normal subjects by noninvasive techniques and autonomic blockade. Eur J Clin Pharmacol 29: 541–547

    Google Scholar 

  30. Mohapatra SN (1981) Non-invasive cardiovascular monitoring by electrical impedance technique. Pitman, London

    Google Scholar 

  31. Stern HC, Wolf GC, Belz GC (1985) Comparative measurement of left ventricular ejection time by mechano-, echo- and electrical impedance cardiography. ArzneimittelForsch 35: 1582–1586

    Google Scholar 

  32. Fitzgerald JD, Ruffin R, Smedstad KG, Roberts R, McAish J (1978) Studies on the pharmacokinetics and pharmacodynamics of atenolol in man. Eur J Clin Pharmacol 13: 81–89

    Google Scholar 

  33. Svedsen TL, Hartling O, Trap-Jensen J (1979) Immediate effects of propranolol and practolol. Eur J Clin Pharmacol 15: 223–228

    Google Scholar 

  34. Findlay IN, MacLeod K, Ford M, Gillen G, Elliott AT, Dargie HJ (1986) Treatment of angina pectoris with nifedipine and atenolol: efficacy and effect on cardiac function. Br Heart J: 240–245

  35. MacClean D, Mitchell ET, Coulson RR, Fitzsimons TJ, McDevitt DG (1988) Atenolol-nifedipine combinations compared to atenolol alone in hypertensive: efficacy and tolerability. Br J Clin Pharmacol 25: 425–431

    Google Scholar 

  36. Joshi PI, Dalal JJ, Ruttley MSJ, Sheridan DJ, Hendersen AH (1981) Nifedipine and left ventricular function in beta-blocked patients. Br Heart J 45: 457–459

    Google Scholar 

  37. Rowland E, Razis P, Sugrue D, Krikler DM (1983) Acute and chronic haemodynamic and electrophysiological effects of nifedipine in patients receiving atenolol. Br Heart J 50: 383–389

    Google Scholar 

  38. Johnston DL, Lesoway R, Humen DP, Kostuk WJ (1985) Clinical and hemodynamic evaluation of propranolol in combination with verapamil, nifedipine, and diltiazem in exertional angina pectoris: A placebo controlled, double blind, randomized, crossover study. Am J Cardiol 55: 680–687

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomas, S.H.L. Comparison of the cardiovascular effects of nifedipine and nicardipine in the presence of atenolol. Eur J Clin Pharmacol 41, 201–206 (1991). https://doi.org/10.1007/BF00315430

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00315430

Key words

Navigation