Effects of Combined Alpha and Beta Adrenoceptor Blockade in Patients with Angina Pectoris. A Double Blind Study Comparing Labetalol with Placebo

Overview

Journal Br Heart J

Specialty Cardiology & Vascular Diseases

Date 1985 Jan 1

PMID 3881105

Citations 7

Authors

A A Quyyumi

C Wright

L Mockus

M Shackell

G C Sutton

K M Fox

Affiliations

Soon will be listed here.

Abstract

The effects of a combined alpha and beta receptor antagonist, labetalol, were investigated in 10 patients with chronic stable angina pectoris. The optimal dose was determined during an initial dose titration study when the patients were treated with 200 mg, 400 mg, and 600 mg (six patients) of labetalol a day. The effective dose was then compared with placebo in a double blind randomised study. The effects of the drug were monitored with angina diaries, treadmill exercise testing, and 48 hour ambulatory electrocardiographic ST segment monitoring. Plasma labetalol concentrations were measured during each treatment period. The mean effective antianginal dose of labetalol was 480 (SD 140) mg/day given by mouth twice a day. There was a dose related reduction in daytime and nocturnal heart rate, the frequency of pain was significantly reduced by 41%, and exercise duration was significantly increased by 44% with labetalol when compared with placebo. The frequency and duration of the episodes of ST segment depression were significantly reduced by 56% and 73% respectively with labetalol. Adverse effects resulted in a reduction of the dose of labetalol in two patients. Thus labetalol is an effective agent in the treatment of angina pectoris.

Citing Articles

Systemic and coronary hemodynamics of labetalol in normotensive patients with ischemic heart disease.

FELDMAN R, Prida X, Lambert C, Hill J Cardiovasc Drugs Ther. 1988; 2(3):355-61.

PMID: 3155428 DOI: 10.1007/BF00054643.

Role of vasodilation in the antihypertensive and antianginal effects of labetalol: implications for therapy of combined hypertension and angina.

Opie L Cardiovasc Drugs Ther. 1988; 2(3):369-76.

PMID: 3154919 DOI: 10.1007/BF00054645.

Labetalol in normotensive patients with angina pectoris.

Fox K, Quyyumi A Cardiovasc Drugs Ther. 1988; 2(3):363-7.

PMID: 3154918 DOI: 10.1007/BF00054644.

Silent ischaemia: clinical implications in 1988.

Fox K Br Heart J. 1988; 60(5):363-6.

PMID: 3060186 PMC: 1216591. DOI: 10.1136/hrt.60.5.363.

Labetalol. A reappraisal of its pharmacology, pharmacokinetics and therapeutic use in hypertension and ischaemic heart disease.

Goa K, Benfield P, Sorkin E Drugs. 1989; 37(5):583-627.

PMID: 2663413 DOI: 10.2165/00003495-198937050-00002.

References

Beilin L, Juel-Jensen B . Alpha and beta adrenergic blockade in hypertension. Lancet. 1972; 1(7758):979-82. DOI: 10.1016/s0140-6736(72)91154-3. View

Rubio R, BERNE R . Regulation of coronary blood flow. Prog Cardiovasc Dis. 1975; 18(2):105-22. DOI: 10.1016/0033-0620(75)90001-8. View

Richards D . Pharmacological effects of labetalol in man. Br J Clin Pharmacol. 1976; 3(4 Suppl 3):721-3. View

Prichard B, Boakes A . Labetalol in long-term treatment of hypertension. Br J Clin Pharmacol. 1976; 3(4 Suppl 3):743-50. View

Orlick A, Ricci D, Alderman E, Stinson E, Harrison D . Effects of alpha adrenergic blockade upon coronary hemodynamics. J Clin Invest. 1978; 62(2):459-67. PMC: 371784. DOI: 10.1172/JCI109147. View

Hillis L, Braunwald E . Coronary-artery spasm. N Engl J Med. 1978; 299(13):695-702. DOI: 10.1056/NEJM197809282991305. View

Braunwald E . Coronary spasm and acute myocardial infarction--new possibility for treatment and prevention. N Engl J Med. 1978; 299(23):1301-3. DOI: 10.1056/NEJM197812072992309. View

Maseri A, Severi S, Nes M, LAbbate A, Chierchia S, Marzilli M . "Variant" angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Pathogenetic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol. 1978; 42(6):1019-35. DOI: 10.1016/0002-9149(78)90691-4. View

Frishman W, Halprin S . Clinical pharmacology of the new beta-adrenergic blocking drugs. Part 7. New horizons in beta-adrenoceptor blockade therapy: labetalol. Am Heart J. 1979; 98(5):660-5. DOI: 10.1016/0002-8703(79)90294-1. View

10.

Trounce J . Dosage and the pharmacokinetics of cytotoxic drugs. Br J Clin Pharmacol. 1979; 8(3):205-7. PMC: 1429797. DOI: 10.1111/j.1365-2125.1979.tb01003.x. View

11.

Thadani U, Davidson C, Singleton W, Taylor S . Comparison of five beta-adrenoreceptor antagonists with different ancillary properties during sustained twice daily therapy in angina pectoris. Am J Med. 1980; 68(2):243-50. DOI: 10.1016/0002-9343(80)90361-7. View

12.

Frishman W, Strom J, Kirschner M, Poland M, Klein N, Halprin S . Labetalol therapy in patients with systemic hypertension and angina pectoris: effects of combined alpha and beta adrenoceptor blockade. Am J Cardiol. 1981; 48(5):917-28. DOI: 10.1016/0002-9149(81)90359-3. View

13.

Gorlin R . Role of coronary vasospasm in the pathogenesis of myocardial ischemia and angina pectoris. Am Heart J. 1982; 103(4 Pt 2):598-603. DOI: 10.1016/0002-8703(82)90463-x. View

14.

Gagnon R, Morissette M, Presant S, Savard D, Lemire J . Hemodynamic and coronary effects of intravenous labetalol in coronary artery disease. Am J Cardiol. 1982; 49(5):1267-9. DOI: 10.1016/0002-9149(82)90054-6. View

15.

Lubbe W, White D . Beneficial effect of labetalol in hypertensive patients with angina pectoris. S Afr Med J. 1983; 63(3):67-71. View

16.

Baum T, Sybertz E . Pharmacology of labetalol in experimental animals. Am J Med. 1983; 75(4A):15-23. DOI: 10.1016/0002-9343(83)90132-8. View

17.

Mehta J, FELDMAN R, Marx J, Kelly G . Systemic, pulmonary, and coronary hemodynamic effects of labetalol in hypertensive subjects. Am J Med. 1983; 75(4A):32-9. DOI: 10.1016/0002-9343(83)90134-1. View

18.

Davidov M, Moir G, Poland M, Maloy J, MEDAKOVIC M . Monotherapy with labetalol in the treatment of mild hypertension: a double-blind study. Am J Med. 1983; 75(4A):47-53. DOI: 10.1016/0002-9343(83)90136-5. View

19.

Frishman W, Michelson E, Johnson B, Poland M . Multiclinic comparison of labetalol to metoprolol in treatment of mild to moderate systemic hypertension. Am J Med. 1983; 75(4A):54-67. DOI: 10.1016/0002-9343(83)90137-7. View

20.

Moyer J, CAPLOVITZ C . The clinical results of oral and parenteral administration of 2-(N'p-tolyl-N'-m-hydroxyphenylaminomethyl) imidazoline hydrochloride (regitine) in the treatment of hypertension and an evaluation of the cerebral hemodynamic effects. Am Heart J. 1953; 45(4):602-10. DOI: 10.1016/0002-8703(53)90170-7. View