~-BLOCKeRS vie AGAINST ANGINAL PAIN

Propranolol given qid gave more steady control of angina than once daily oltprenolol in a double-blind crossover study in 23 patients with stable angina pectoris. They were given 160mg of slow release oxprenolol once daily for 1 month, and during another rnOnlh, 40mg of propranolol qid . On oxprenoloJ. the patienlS experienced an average of II anginal attacks, while on propranolol they had 8. The resting heart rates were higher 7.5 and 24 hours after oxprenolol than they were 4 and 12 hours after propranolol. Treadmill walking time to the onset of angina was less after oxprenolol than propranolol. 24 hours after a dose,

oxprenolol produced insufficient IS-blockade. as a .. sessed by high heart rate, systolic BP and rale-pressure product du ring exercise. IS-blockade was more consistently ach ieved by propranolol. [Ololl/Qyeye, J.O. el 01.: American lOl/fllal a/Cardiology -17: 1123 (May /981)]. Once daily atenolol remai ned effective for a year in coronary disease patients given 100 or 200mg once daily. During early and chronic atenolol therapy, glyceryl trinitrate (nitroglycerin) consumption and anginal frequency were significantly decreased. 24·hour ECG and treadmill exercise tests showed sustained heart rate suppression. Atenolo( consistently increased tile duration of exercise tolerance. The maximal benefits of atenolol were not reached until 3 months of therapy despite stable drug levels. [Schwanz. J.8. el al .: Americon llear, Journal 10' : 380 (Apr 1981A. IV metoprolol (2.5-20mg) produced dose-dependent changes in haemodynamics in 12 patients with coronary hean disease. The greatest changes in haemodynamic parameters were seen with higher doses, though signifICant changes occurred withjuSl 2.5mg. After a cumulative dose 0(20mg, systolic BP had fallen by 8% (from 140 to 136mm Hg), diaslOlic BP by 5 % (from 84 to 80mm Hg), heart rate by 17 % (from 76 to 63 beats/m in). and cardiac index by 17 % (from 3.5 to 2.9L1 min/m l ) . Pulmonary wedge pressure had increased by 50% (from 10 to f 5mm Hg). Similar haemodynam ic changes occurred during exercise. The authors concluded thai IV metoprolol may be of value in slates where acute ~.blockade is clinically indicated, but it should probably be given with caution in patients with impaired pumping activity. [Hendry, w.G. et 01.: Ellropeall Jourl/al o/Clinicol Pharmacology

19: 313 (No 5, 1981l Exercise duration increa..;ed in all of8 patients with angina 2 hours after tim%l , I 0-30mg, was given in a double-blind randomised crossover study. Exercise duration as measured 2 and 12 hours after dosing. Compared with placebo. mean exercise duration increased signifICantly by '" 25 % in all patients at 2 hours and in 3 of 7 patienlS(43%) at 12 hours. Timolol I 0-30mg bid consistently reduced systolic and diastolic BP and resting hean rale at the onset of angina pectoris or marked fatigue. 'We feel that timolol is en excellent antianginal for improving exercise tolerance for 2 hours after medication, ' the authors conclude iA rOIlOIl', w.s. ef 01.: Clillical Pharmacology alld Therapeutics 19: J 55 {Feb 1981!/

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