A Comparison of the Acute Hemodynamic Effects of Nifedipine and Nisoldipine in Patients with Ischemic Reduced Left Ventricular Function

Summary

Nisoldipine (Bay k 5552), like nifedipine, is a dihydropyridine compound with strong calcium blocking activity. The purpose of this study was to measure and compare the absolute hemodynamic effects of these two drugs before and at 30, 60, and 120 min after oral intake in 20 patients with confirmed ischemic heart disease using radionuclide gated cardiac scintigraphy. No significant change was seen in end diastolic volume index with either of the drugs. With nifedipine the stroke volume index (SVI) increased significantly from the basal value at 30 (P = 0.004) and 60 min (P = 0.034), yet was not significant at 120 min. The same tendency was seen in the left ventricular ejection fraction (LVEF) with significant increases at 30 min (P = 0.02) and 60 min (P = 0.025) but not significant at 120 min. The cardiac index increased significantly at 30 (P = 0.001), 60 (P = 0.002), and 120 min (P = 0.025), but the 120 min value was significantly lower than the 30-min value, indicating that the maximal effect had already passed.

With nisoldipine the SVI increased significantly at 60 (P = 0.004) and 120 min (P = 0.001) but not at 30 min. These changes were again reflected by a significant increase in LVEF at 60 (P = 0.021) and 120 min (P = 0.002) without significant increase at 30 min. The increase in CI was highly significant at 60 (P = 0.003) and 120 min (P = 0.001), without significant change at 30 min. Thus, nisoldipine proves to be more potent than nifedipine, with slower onset and longer duration of action.