Skip to main content
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1990 Apr;29(4):437–445. doi: 10.1111/j.1365-2125.1990.tb03662.x

Haemodynamic and radionuclide effects of amlodipine in coronary artery disease.

B Silke 1, S P Verma 1, A V Zezulka 1, S Sharma 1, G Reynolds 1, N C Jackson 1, S Guy 1, S H Taylor 1
PMCID: PMC1380114  PMID: 2139339

Abstract

1. The haemodynamic and radionuclide effects of a new long-acting slow-calcium channel blocking agent, amlodipine, were evaluated in 32 patients with coronary artery disease. 2. Haemodynamic measurements in 24 patients were made at rest and 10 to 15 min after 20 mg i.v. amlodipine. Amlodipine significantly reduced systemic arterial blood pressure and vascular resistance index with an increased heart rate and augmented cardiac index. Cardiac stroke volume index rose and stroke work fell without change in pulmonary artery occluded pressure (PAOP). 3. The exercise effects were determined by comparison of measurements during 4 min of supine bicycle exercise at a fixed workload before and after drug treatment. During dynamic exercise, amlodipine reduced systemic arterial pressure and vascular resistance index. Exercise cardiac index, stroke volume index and heart rate were higher. The left ventricular filling pressure was significantly reduced. 4. Radionuclide parameters were studied in 16 patients at rest and on exercise; ejection fraction was unaltered following amlodipine. 5. Pre-therapy haemodynamic values correlated with response following amlodipine for resting mean blood pressure, systemic vascular resistance and exercise PAOP. 6. Thus, the immediate impact of amlodipine in stable coronary artery disease was to reduce left ventricular afterload and thereby improve cardiac pumping performance.

Full text

PDF
437

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amlie J. P., Landmark K. The effect of nifedipine on the sinus and atrioventricular node of the dog heart after beta-adrenergic receptor blockade. Acta Pharmacol Toxicol (Copenh) 1978 Apr;42(4):287–291. doi: 10.1111/j.1600-0773.1978.tb02203.x. [DOI] [PubMed] [Google Scholar]
  2. Anderson J. L., Wagner J. M., Datz F. L., Christian P. E., Bray B. E., Taylor A. T. Comparative effects of diltiazem, propranolol, and placebo on exercise performance using radionuclide ventriculography in patients with symptomatic coronary artery disease: results of a double-blind, randomized, crossover study. Am Heart J. 1984 Apr;107(4):698–706. doi: 10.1016/0002-8703(84)90317-x. [DOI] [PubMed] [Google Scholar]
  3. Atterhög J. H., Ekelund L. G., Melin A. L. Effect of nifedipine on exercise tolerance in patients with angina pectoris. Eur J Clin Pharmacol. 1975 Feb 28;8(2):125–130. doi: 10.1007/BF00561561. [DOI] [PubMed] [Google Scholar]
  4. Bacharach S. L., Green M. V., Borer J. S., Ostrow H. G., Redwood D. R., Johnston G. S. ECG-gated scintillation probe measurement of left ventricular function. J Nucl Med. 1977 Dec;18(12):1176–1183. [PubMed] [Google Scholar]
  5. Berger H. J., Davies R. A., Batsford W. P., Hoffer P. B., Gottschalk A., Zaret B. L. Beat-to-beat left ventricular performance assessed from the equilibrium cardiac blood pool using a computerized nuclear probe. Circulation. 1981 Jan;63(1):133–142. doi: 10.1161/01.cir.63.1.133. [DOI] [PubMed] [Google Scholar]
  6. Chew C. Y., Hecht H. S., Collett J. T., McAllister R. G., Singh B. N. Influence of severity of ventricular dysfunction on hemodynamic responses to intravenously administered verapamil in ischemic heart disease. Am J Cardiol. 1981 Apr;47(4):917–922. doi: 10.1016/0002-9149(81)90194-6. [DOI] [PubMed] [Google Scholar]
  7. Faulkner J. K., McGibney D., Chasseaud L. F., Perry J. L., Taylor I. W. The pharmacokinetics of amlodipine in healthy volunteers after single intravenous and oral doses and after 14 repeated oral doses given once daily. Br J Clin Pharmacol. 1986 Jul;22(1):21–25. doi: 10.1111/j.1365-2125.1986.tb02874.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Guazzi M., Olivari M. T., Polese A., Fiorentini C., Magrini F., Moruzzi P. Nifedipine, a new antihypertensive with rapid action. Clin Pharmacol Ther. 1977 Nov;22(5 Pt 1):528–532. doi: 10.1002/cpt1977225part1528. [DOI] [PubMed] [Google Scholar]
  9. Hossack K. F., Bruce R. A., Ritterman J. B., Kusumi F., Trimble S. Divergent effects of diltiazem in patients with exertional angina. Am J Cardiol. 1982 Feb 18;49(3):538–546. doi: 10.1016/s0002-9149(82)80009-x. [DOI] [PubMed] [Google Scholar]
  10. Hung J., Lamb I. H., Connolly S. J., Jutzy K. R., Goris M. L., Schroeder J. S. The effect of diltiazem and propranolol, alone and in combination, on exercise performance and left ventricular function in patients with stable effort angina: a double-blind, randomized, and placebo-controlled study. Circulation. 1983 Sep;68(3):560–567. doi: 10.1161/01.cir.68.3.560. [DOI] [PubMed] [Google Scholar]
  11. Josephson M. A., Hopkins J., Singh B. N. Hemodynamic and metabolic effects of diltiazem during coronary sinus pacing with particular reference to left ventricular ejection fraction. Am J Cardiol. 1985 Feb 1;55(4):286–290. doi: 10.1016/0002-9149(85)90362-5. [DOI] [PubMed] [Google Scholar]
  12. Kieval J., Myerburg R. J. The hemodynamic effects of calcium channel blocking agents: a brief review. Angiology. 1982 Aug;33(8):516–521. doi: 10.1177/000331978203300803. [DOI] [PubMed] [Google Scholar]
  13. Klein H. O., Ninio R., Oren V., Lang R., Sareli P., DiSegni E., David D., Guerrero J., Kaplinsky E. The acute hemodynamic effects of intravenous verapamil in coronary artery disease. Assessment by equilibrium-gated radionuclide ventriculography. Circulation. 1983 Jan;67(1):101–110. doi: 10.1161/01.cir.67.1.101. [DOI] [PubMed] [Google Scholar]
  14. Lahiri A., Bowles M. J., Jones R. I., Crawley J. C., Raftery E. B. Assessment of left ventricular function in coronary artery disease with the nuclear probe during intervention studies. Br Heart J. 1984 Oct;52(4):422–430. doi: 10.1136/hrt.52.4.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lambert C. R., Hill J. A., Nichols W. W., Feldman R. L., Pepine C. J. Coronary and systemic hemodynamic effects of nicardipine. Am J Cardiol. 1985 Mar 1;55(6):652–656. doi: 10.1016/0002-9149(85)90130-4. [DOI] [PubMed] [Google Scholar]
  16. Legrand V., Hastir F., Vandormael M., Collignon P., Kulbertus H. E. Haemodynamic effects of intravenous diltiazem at rest and exercise in patients with coronary artery disease. Eur Heart J. 1984 Jun;5(6):456–463. doi: 10.1093/oxfordjournals.eurheartj.a061691. [DOI] [PubMed] [Google Scholar]
  17. Moskowitz R. M., Piccini P. A., Nacarelli G. V., Zelis R. Nifedipine therapy for stable angina pectoris: preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol. 1979 Oct 22;44(5):811–816. doi: 10.1016/0002-9149(79)90202-9. [DOI] [PubMed] [Google Scholar]
  18. Murakami M., Murakami E., Takekoshi N., Tsuchiya M., Kin T. Antihypertensive effect of (4-2'-nitrophenyl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarbonic acid dimethylester (Nifedipine, Bay-a 1040), a new coronary dilator. Jpn Heart J. 1972 Mar;13(2):128–135. doi: 10.1536/ihj.13.128. [DOI] [PubMed] [Google Scholar]
  19. Opie L. H. Drugs and the heart. III. Calcium antagonists. Lancet. 1980 Apr 12;1(8172):806–810. doi: 10.1016/s0140-6736(80)91303-3. [DOI] [PubMed] [Google Scholar]
  20. Pouleur H., Etienne J., Van Mechelen H., Van Eyll C., Charlier A. A., Brasseur L. A., Rousseau M. F. Effects of nicardipine or nifedipine added to propranolol in patients with coronary artery disease. Postgrad Med J. 1984;60 (Suppl 4):23–28. [PubMed] [Google Scholar]
  21. Rousseau M. F., Etienne J., Van Mechelen H., Veriter C., Pouleur H. Hemodynamic and cardiac effects of nicardipine in patients with coronary artery disease. J Cardiovasc Pharmacol. 1984 Sep-Oct;6(5):833–839. doi: 10.1097/00005344-198409000-00015. [DOI] [PubMed] [Google Scholar]
  22. Rousseau M. F., Vincent M. F., Van Hoof F., Van den Berghe G., Charlier A. A., Pouleur H. Effects of nicardipine and nisoldipine on myocardial metabolism, coronary blood flow and oxygen supply in angina pectoris. Am J Cardiol. 1984 Dec 1;54(10):1189–1194. doi: 10.1016/s0002-9149(84)80065-x. [DOI] [PubMed] [Google Scholar]
  23. Scheidt S., Lewinter M. M., Hermanovich J., Venkataraman K., Freedman D. Nicardipine for stable angina pectoris. Br J Clin Pharmacol. 1985;20 (Suppl 1):178S–186S. doi: 10.1111/j.1365-2125.1985.tb05162.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Seabra-Gomes R., Rickards A., Sutton R. Hemodynamic effects of verapamil and practolol in man. Eur J Cardiol. 1976 Mar;4(1):79–85. [PubMed] [Google Scholar]
  25. Silke B., Frais M. A., Midtbo K. A., Verma S. P., Sharma S., Reynolds G., Jackson N., Taylor S. H. Comparative hemodynamic dose-response effects of five slow calcium channel-blocking agents in coronary artery disease. Clin Pharmacol Ther. 1987 Oct;42(4):381–387. doi: 10.1038/clpt.1987.167. [DOI] [PubMed] [Google Scholar]
  26. Silke B., Frais M. A., Muller P., Verma S. P., Reynolds G., Taylor S. H. Haemodynamic dose-response effects of intravenous nisoldipine in coronary artery disease. Br J Clin Pharmacol. 1985 Dec;20(6):675–680. doi: 10.1111/j.1365-2125.1985.tb05127.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Silke B., Graham D. J., Verma S. P., Reynolds G., Frais M. A., Finlayson J. R., Taylor S. H. Pharmacokinetic, haemodynamic and radionuclide studies with nicardipine in coronary artery disease. Eur J Clin Pharmacol. 1986;29(6):651–657. doi: 10.1007/BF00615954. [DOI] [PubMed] [Google Scholar]
  28. Silke B., Sharma S. K., Verma S. P., Midtbo K. A., Reynolds G., Taylor S. H. A haemodynamic and radionuclide assessment of diltiazem in coronary heart disease. Br J Clin Pharmacol. 1987 Feb;23(2):165–172. doi: 10.1111/j.1365-2125.1987.tb03025.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Silke B., Verma S. P., Ahuja R. C., Nelson G. I., Hussain M., Taylor S. H. Haemodynamic dose-response effects of i.v. verapamil in coronary artery disease. Herz. 1984 Dec;9(6):353–361. [PubMed] [Google Scholar]
  30. Silke B., Verma S. P., Frais M. A., Hafizullah M., Taylor S. H. Effects of nicardipine on cardiac volume at rest and during exercise-induced angina. Br J Clin Pharmacol. 1985;20 (Suppl 1):169S–176S. doi: 10.1111/j.1365-2125.1985.tb05161.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Silke B., Verma S. P., Nelson G. I., Hussain M., Taylor S. H. Haemodynamic dose-response effects of i.v. nicardipine in coronary artery disease. Br J Clin Pharmacol. 1984 Nov;18(5):717–724. doi: 10.1111/j.1365-2125.1984.tb02534.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Simonsen S., Nitter-Hauge S. Effect of nifedipine (Adalat) on coronary haemodynamics in patients with coronary arteriosclerotic disease. Acta Med Scand. 1978;204(3):179–184. doi: 10.1111/j.0954-6820.1978.tb08421.x. [DOI] [PubMed] [Google Scholar]
  33. Singh B. N. Pharmacological basis for the therapeutic applications of slow-channel blocking drugs. Angiology. 1982 Aug;33(8):492–515. doi: 10.1177/000331978203300802. [DOI] [PubMed] [Google Scholar]
  34. Singh B. N., Roche A. H. Effects of intravenous verapamil on hemodynamics in patients with heart disease. Am Heart J. 1977 Nov;94(5):593–599. doi: 10.1016/s0002-8703(77)80128-2. [DOI] [PubMed] [Google Scholar]
  35. Stone P. H., Antman E. M., Muller J. E., Braunwald E. Calcium channel blocking agents in the treatment of cardiovascular disorders. Part II: Hemodynamic effects and clinical applications. Ann Intern Med. 1980 Dec;93(6):886–904. doi: 10.7326/0003-4819-93-6-886. [DOI] [PubMed] [Google Scholar]
  36. Strashun A., Horowitz S. F., Goldsmith S. J., Teichholz L. E., Dicker A., Miceli K., Gorlin R. Noninvasive detection of left ventricular dysfunction with a portable electrocardiographic gated scintillation probe device. Am J Cardiol. 1981 Mar;47(3):610–617. doi: 10.1016/0002-9149(81)90545-2. [DOI] [PubMed] [Google Scholar]
  37. Visser C. A., Jaarsma W., Kan G., Koolen J. J., Lie K. I. Immediate and long-term effects of nicardipine, at rest and during exercise, in patients with coronary artery disease. Br J Clin Pharmacol. 1985;20 (Suppl 1):158S–162S. doi: 10.1111/j.1365-2125.1985.tb05159.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Vogt A., Kreuzer H. Hemodynamic effects of nisoldipine in chronic congestive heart failure. Arzneimittelforschung. 1983;33(6):877–879. [PubMed] [Google Scholar]
  39. Vogt A., Neuhaus K. L., Kreuzer H. Hemodynamic effects of the new vasodilator drug Bay k 5552 in man. Arzneimittelforschung. 1980;30(12):2162–2164. [PubMed] [Google Scholar]
  40. Wagner H. N., Jr The nuclear cardiac probe. Hosp Pract (Hosp Ed) 1982 Apr;17(4):163-5, 169-77. doi: 10.1080/21548331.1982.11698063. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES