[The acute hemodynamic effects of the new vasodilating beta blocker carvedilol in comparison with combined administration of nifedipine and propranolol in patients with coronary heart disease].

The acute hemodynamic effects of carvedilol, a new vasodilating betablocker, were assessed in comparison to the response to nifedipine or a combination of nifedipine and propranolol in patients with coronary artery disease. Either 5 mg carvedilol, 2 mg nifedipine or 2 mg nifedipine + 5 mg propranolol (N + P) were administered intravenously in a not randomized study within 30 min to 10 patients for each drug. Carvedilol reduced (comparable to the effect of N + P) the left ventricular afterload with a decrease of AOPm of 12.6%, p less than 0.001 (N + P -11.8%, p less than 0.001) and systemic vascular resistance of 9.1%, p less than 0.02 (N + P -10.0%, p less than 0.01) and no change of cardiac index. Single treatment with nifedipine leads to a reflex increase of heart rate which could not be observed after carvedilol or N + P as a result of the betablocking properties of carvedilol and propranolol. Therefore, the rate-pressure-product at rest was unchanged after nifedipine but decreased significantly after carvedilol (-10.9%, p less than 0.01) and N + P (-12.4%, p less than 0.01). Negative inotropic effects were significantly lower after carvedilol, with a 6.3% (p less than 0.05) decrease of LV dP/dtmax, compared to N + P (-12.0%, p less than 0.01). Since preload, afterload, and heart rate changes were equal in both groups negative inotropic effects can be compared on the base of dP/dtmax changes. The acute hemodynamic effects (vasodilation without reflex tachycardia, negative inotropic effects) of the new vasodilating betablocker carvedilol are comparable to a combined treatment with nifedipine and propranolol in patients with coronary artery disease and well preserved left ventricular global function.