Effect of amlodipine, atenolol and their combination on myocardial ischemia during treadmill exercise and ambulatory monitoring

Abstract

Ischemia during treadmill testing was more effectively suppressed by amlodipine, whereas ischemia during ambulatory monitoring was more effectively suppressed by atenolol. The combination was more effective than either single drug in both settings.

Influence of Atenolol and Nifedipine on Nitric-Oxide Deficient Cardiomyocyte Hypertrophy and Expression of the Cardio-Endocrine Peptide Intermedin and its Receptor Components

“…Secondly, the vascular selective calcium channel blocker nifedipine was chosen for ability to increase myocardial oxygen supply as a consequence of coronary vasodilatation, and to reduce myocardial oxygen consumption by reducing preload and after-load as a consequence of systemic vasodilatation [19]; both effects are due to direct relaxation of vascular smooth muscle independent of NO release, in contrast to the action of hydralazine which is primarily an arteriolar dilator, whose mechanism is dependent in part on NO-related cyclic GMP accumulation [20] and likely to be influenced by NO-deficiency. Dihydropyridine calcium channel modulators, including nifedipine, can also scavenge ROS [21].…”

Delayed Preconditioning-Mimetic Actions of Nitroglycerin in Patients Undergoing Exercise Tolerance Tests

“…23 In a crossover study of 100 patients with stable angina undergoing repeated ETTs (Bruce protocol), total exercise time increased by 38, 13, and 55 seconds, respectively, in patients receiving amlodipine, atenolol, or their combination. 24 In another study of 170 patients with stable angina, diltiazem CD was associated with a 16-second increase in total exercise duration on repeated ETTs when added to existing antianginal therapy. 25 Our study was performed in a selected cohort of patients at the Veteran's Administration Hospital.…”

Silent Myocardial Ischemia

“…97,101 However, the addition of a calcium antagonist to ␤ blockade has been shown to improve objective measures of ischemia, 102,103 and the combination of both types of agents has been found to be superior to either type alone in reducing ischemia. 99,104 An elegant study by Andrews et al 105 casts some light over the possible mechanism involved in the additive effect of combination therapy. They demonstrated 3 distinct subtypes of ambulatory ischemia, 2 of which are associated with minor but significant heart rate increases and a third not associated with any increase in heart rate.…”