Beneficial enhancement of coronary blood flow by nifedipine: Comparison with nitroglycerin and beta blocking agents

Heinz-Jurgen Engel; Paul R. Lichtlen

doi:10.1016/0002-9343(81)90230-8

Symposium on nifedipine in angina pectoris| Volume 71, ISSUE 4, P658-666, October 01, 1981

Beneficial enhancement of coronary blood flow by nifedipine

Comparison with nitroglycerin and beta blocking agents

Heinz-Jurgen Engel, M.D.
Heinz-Jurgen Engel
Correspondence
Requests for reprints should be addressed to Dr. Heinz-Jurgen Engel, Director, Division of Cardiology, Zentralkrankenhaus, “Links der Weser,” 2800 Bremen 61, West Germany.
Footnotes
Affiliations
Bremen, West Germany
Search for articles by this author
Paul R. Lichtlen, M.D.
Paul R. Lichtlen
Footnotes
Affiliations
Hannover, West Germany
Search for articles by this author
Show footnotesHide footnotes
Author Footnotes
1 From the Division of Cardiology, Zentralkrankenhaus, Bremen, West Germany.
2 From the Departments of Medicine and Cardiology, Hannover Medical School, Hannover, West Germany.

DOI:https://doi.org/10.1016/0002-9343(81)90230-8

This paper is only available as a PDF. To read, Please Download here.

Abstract

In 36 patients with isolated stenoses (70 percent or greater) of the anterior descending or circumflex branches of the left coronary artery, regional myocardial blood flow was assessed using xenon¹³³ washout at rest and during pacing-induced ischemia, and during atrial pacing at identical heart rates, after the following agents had been given sublingually: nifedipine, 20 mg (11 patients); nitroglycerin, 0.8 mg (12 patients); or propranolol, 5 mg (13 patients). Pacing-induced ischemia was diagnosed by the onset of angina, the appearance on the electrocardiogram of ST depression of at least 0.1 millivolt, or both.

The following changes in myocardial blood flow in poststenotic and normal areas of the left ventricle, and in the rate-pressure product, were observed:

Tabled 1

	Myocardial Blood Flow (ml/min. '100 g)
	Poststenotic Areas	Normal Areas	Rate-Pressure Product (× 10⁻²)
1. Control	57.1 ± 10.4	70.7 ± 12.8	Rate-Pressure Product (× 10⁻²)	96.9
2. Pacing-induced ischemia	77.6 ± 20.7	91.2 ± 18.5	181.7
3. 2 + nifedipine	82.3 ± 14.8	86.8 ± 14.8	142.0
1. Control	55.3 ± 8.6	66.2 ± 12.5	97.4
2. Pacing-induced ischemia	76.9 ± 12.1	95.0 ± 14.5	180.4
3. 2 + nitroglycerin	68.1 ± 11.6	72.4 ± 16.1	151.6
1. Control	52.8 ± 10.4	63.7 ± 12.5	84.9
2. Pacing-induced ischemia	75.3 ± 10.7	87.3 ± 15.3	153.5
3. 2 + propranolol	63.4 ± 9.6	70.2 ± 12.8	155.5

Open table in a new tab

The coronary-sinus oxygen concentration was recorded continuously and did not decrease after propranolol.

The antianginal mechanism of nifedipine thus differs markedly from the effects seen with both nitrates and beta blocking agents. Nifedipine decreases peripheral resistance, thereby decreasing afterload, and increases myocardial blood flow by reducing coronary resistance; nitrates reduce pre- and afterload and accordingly decrease myocardial blood flow by autoregulation (exceptions are variant angina and severe ischemia with increased compressive resistance attributable to elevated left ventricular diastolic pressure); beta blocking agents reduce myocardial oxygen consumption by direct cardiac action and secondarily reduce myocardial blood flow (by autoregulation rather than vasoconstriction resulting from unopposed alpha-adrenergic tone).

To read this article in full you will need to make a payment

Purchase one-time access:

One-time access price info

For academic or personal research use, select 'Academic and Personal'
For corporate R&D use, select 'Corporate R&D Professionals'

Subscribe:

Already a print subscriber? Claim online access

Already an online subscriber? Sign in

Register: Create an account

Institutional Access: Sign in to ScienceDirect

References

- Imai S
Effects of nifedipine on heart and circulation.
in: Hashimoto K Kimura E Kobayashi T 1st International Nifedipine “Adalat” Symposium. University of Tokyo Press, Tokyo1973: 23
- Google Scholar
- Lichtlen P
- Engel H-J
- Amende I
- et al.
Mechanism of various antianginal drugs. Relationship between regional flow behavior and contractility.
in: Jatene AD Lichtlen PR 3rd International “Adalat” Symposium. Excerpta Medica, Amsterdam-Oxford1976: 14
- Google Scholar
- Engel H-J
Assessment of regional myocardial blood flow by the precordial ¹³³xenon clearance technique.
in: Schaper W The pathophysiology of myocardial perfusion. Elsevier/North Holland Biomedical Press B.V, Amsterdam1979: 58
- Google Scholar
- Herman MF
- Heinle RA
- Klein MD
- et al.
Localized disorders in myocardial contraction. Asynergy and its role in congestive heart failure.
N Engl J Med. 1967; 277: 222
- Leighton RF
- Wilt SM
- Lewis RP
Detection of hypokinesis by a quantitative analysis of left ventricular cineangiograms.
Circulation. 1974; 50: 121
- Cannon PJ
- Dell RB
- Dwyer Jr, EM
Measurement of regional myocardial perfusion in man with ¹³³xenon and a scintillation camera.
J Clin Invest. 1972; 51: 964
- Holman BL
- Adams DF
- Jewitt D
- et al.
Measuring regional myocardial blood flow with ¹³³Xe and the Anger camera.
Radiology. 1974; 112: 99
- Hundeshagen H
- Geisler S
- Dittman P
- et al.
Quantitative scintigraphic display of the myocardial blood flow technique and clinical evaluation.
Eur J Nucl Med. 1976; 1: 107
- PubMed
- Google Scholar
- Ross RS
- Ueda K
- Lichtlen PR
- et al.
Measurement of myocardial blood flow in animal and man by selective injection of radioactive inert gas into the coronary arteries.
Circ Res. 1964; 15: 28
- Kloster FE
- Friesen WG
- Green GS
- et al.
Effects of coronary arteriography on myocardial blood flow.
Circulation. 1972; 46: 438
- Kety SS
- Schmidt CF
The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations.
Am J Physiol. 1945; 143: 53
- Crossref
- Google Scholar
- Conn Jr, HL
Equilibrium distribution of radioxenon in tissue: xenon-hemoglobin association curve.
J Appl Physiol. 1961; 16: 1065
- PubMed
- Google Scholar
- Herd JA
- Hollenberg M
- Thronburn GD
- et al.
Myocardial blood flow determined with krypton 85 in unanesthetized dogs.
Am J Physiol. 1962; 203: 122
- PubMed
- Google Scholar
- Leutenegger F
- Rafflenbeul W
- Gahl K
- et al.
Quantitative Koronarangiographie: Dilation von Koronoraspasmen nach Nifedipin.
Schweiz Med Wchenschr. 1980; 110: 1703
- Google Scholar
- Lichtlen P
The influence of nifedipine on left ventricular and coronary dynamics at rest and during exercise in patients with coronary artery disease.
in: Hashimoto K Kimura E Kobayashi T 1st International Nifedipine “Adalat” Symposium. University of Tokyo Press, Tokyo1973: 114
- Google Scholar
- Hoffman JIE
- Buckberg GD
Transmural variations in myocardial perfusion.
in: Yu PN Goodwin JF Progress in Cardiology 5. Lea & Febiger, Philadelphia1976: 37
- Google Scholar
- Becker L
- Pitt B
Regional myocardial blood flow, ischemia and antianginal drugs.
Ann Clin Res. 1971; 3: 353
- PubMed
- Google Scholar
- Mathes P
- Rival J
Effect of nitroglycerin on total and regional coronary blood flow in the normal and ischemic canine myocardium.
Cardiovasc Res. 1971; 5: 54
- Winbury NM
Experimental studies on the mechanism of action of nitrates and beta-adrenergic blockers.
in: Pharmacologie clinique des médicaments antiangineux. Edition Sandoz, Paris1974: 153
- Google Scholar
- Lichtlen P
- Engel H-J
- Wolf R
- et al.
Regional myocardial blood flow in patients with coronary disease after nifedipine.
in: Lichtlen PR Kimura E Taira N International Adalat Panel Discussion. New experimental and clinical results. Excerpta Medica, Amsterdam1979: 69
- Google Scholar

Article Info

Identification

DOI: https://doi.org/10.1016/0002-9343(81)90230-8

Copyright

ScienceDirect

Access this article on ScienceDirect

Property	Value
Status
Version
Ad File
Disable Ads Flag
Environment
Moat Init
Moat Ready
Contextual Ready
Contextual URL
Contextual Initial Segments
Contextual Used Segments
AdUnit
SubAdUnit
Custom Targeting
Ad Events
Invalid Ad Sizes