Summary
Combined action drugs is a term applied to describe antihypertensive agents which lower blood pressure by interference with more than one physiological mechanism contributing to the genesis and maintenance of hypertension. In this group numerous compounds have been developed which have an antagonistic effect on β-adrenoceptors and at the same time achieve other effects, for example vasodilatation, usually through an antagonistic effect at α-adrenoceptor sites. In view of the multifactorial aetiology of essential hypertension, it is logical to try to reduce the elevated arterial pressure in this condition by interfering with more than one mechanism. It seems to be important that a vasodilating component is present, since the hallmark of established essential hypertension is increased total peripheral resistance. Thus, a combined action drug with a vasodilating component will lower blood pressure and at the same time maintain organ perfusion.
A β-adrenoceptor blocking component is also desirable in view of the proven secondary prevention against coronary heart disease obtained with β-blockers and the proposed primary preventive effect attributable to β-blockade.
Finally, since the combination of β-blockade and vasodilatation (e.g. due to peripheral α1-blockade) usually does not induce metabolic disturbances, agents of this kind are not likely to elevate serum lipoproteins.
Thus, this paper will briefly review the use of the combined action drug carvedilol in the treatment of hypertension.
Similar content being viewed by others
References
Chobanian AV, Brecher P, Chan C. Effects of propranolol on atherogenesis in the cholesterol-fed rabbit. Circulation Research 56: 755–762, 1985
Cubeddu LX, Fuenmayor N, Varin F, Villagra VG, Colindres RE, et al. Clinical pharmacology of carvedilol in normal volunteers. Clinical Pharmacology and Therapeutics 41: 31–44, 1987
Eggertsen R, Andren L, Sivertsson R, Hansson L. Acute haemodynamic effects of carvedilol (BM 14190), a new combined beta-adrenoceptor blocker and precapillary vasodilating agent, in hypertensive patients. European Journal of Clinical Pharmacology 27: 19–22, 1984a
Eggertsen R, Sivertsson R, Andrén L, Hansson L. Haemodynamic effects of carvedilol, a new beta-adrenoceptor blocker and precapillary vasodilator, in essential hypertension. Journal of Hypertension 2: 529–534, 1984b
Freis ED. Hemodynamics in hypertension. Physiological Reviews 40: 27–54, 1960
Hansson L. What have we achieved? Journal of Cardiovascular Pharmacology 10 (Suppl. 11): S151, 1987
Heber ME, Brigden GS, Caruana MP, Lahiri A, Raftery EB. Carvedilol for systemic hypertension. American Journal of Cardiology 59: 400–405, 1987
Julius S, Hansson L. Hemodynamics of prehypertension and hypertension. Verhandlungen der deutschen Gesellschafft für innere Medizin 80: 49–58, 1974
Kaski JC, Rodriguez-Plaza L, Brown J, Maseri A. Efficacy of carvedilol (BM 14,190), a new beta-blocking drug with vasodilating properties, in exercise-induced ischemia. American Journal of Cardiology 56: 35–40, 1985
Meyer-Sabellek WA, Schulte K-L, Thiede HM, Gotzen R. Acute hypotensive responses to the new antihypertensive agent BM 1190 in essential hypertensive patients. Journal of Hypertension 1 (Suppl. 2): 351–352, 1983
Meyer-Sabellek W, Schulte K-L, Kloppenburg-Steinecke F, Perets P, Gotzen R. Wirkprofil des neuen vasodilatierenden Beta-blockers Carvedilol (BM 14190) unter Langzeittherapie bei ambulanten essentiellen Hypertonikern. Therapiewoche 34: 45, 1984
Rodrigues EA, Lahiri A, Hughes LO, Kohli RS, Wittington JR, et al. Antianginal efficacy of carvedilol, a beta-blocking drug with vasodilating activity. American Journal of Cardiology 58: 916–922, 1986
Schnurr E, Widmann L, Glocke M. Efficacy and safety of carvedilol in the treatment of hypertension. Journal of Cardiovascular Pharmacology 10 (Suppl. 11): S101–S107, 1987
Sponer G, Strein K, Müller-Beckmann B, Bartsch W. Studies on the mode of vasodilating action of carvedilol. Journal of Cardiovascular Pharmacology 10 (Suppl. 11): S42–S48, 1987a
Sponer G, Bartsch W, Strein K, Müller-Beckmann B, Böhm E. Pharmacological profile of carvedilol as a β-blocking agent with vasodilating and hypotensive properties. Journal of Cardiovascular Pharmacology 9: 317–327, 1987b
Strein K, Sponer G, Müller-Beckmann B, Bartsch W. Pharmacological profile of carvedilol, a compound with β-blocking and vasodilating properties. Journal of Cardiovascular Pharmacology 10 (Suppl. 11): S33–S41, 1987
von Möllendorff B, Kühlwein C, Akpan W, Abshagen U. Clinical pharmacology of BM 14.190, a new beta-blocking and vasodilating agent. Naunyn-Schmiedeberg’s Archives of Pharmacology 321 (Suppl. 1): R21, 1982
Wikstrand J, Warnold I, Olsson G, Tuomilehto J, Elmfeldt D, et al. Primary prevention with metoprolol in patients with hypertension. Mortality results from the MAPHY study. Journal of the American Medical Association 259: 1976–1982, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hansson, L. Combined Action Drugs in the Treatment of Hypertension. Drugs 36 (Suppl 6), 26–30 (1988). https://doi.org/10.2165/00003495-198800366-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198800366-00006