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Lack of reflex increase in myocardial sympathetic tone after captopril: potential antianginal effect

, : Lack of reflex increase in myocardial sympathetic tone after captopril: potential antianginal effect. Circulation 71(2): 317-325

Many vasodilators have been tried as antianginal agents, but the reflex increase in sympathetic tone produced by these drugs necessitate their use with caution in patients with angina. In the first part of this study, captopril was given to 14 patients with angina and systolic arterial pressures of > 120 mm Hg. Over the short-term, captopril decreased arterial blood pressure (from 110 .+-. 18 to 98 .+-. 18 mm Hg, P < 0.01) without increasing heart rate (75 .+-. 15 vs. 74 .+-. 15 beats/min), arterial concentrations of epinephrine (0.38 .+-. 0.28 vs. 0.34 .+-. 0.25 nM) or norepinephrine [NE] (2.7 .+-. 2.1 vs. 2.8 .+-. 2.1 nM), or transmyocardial NE balance (216 .+-. 254 vs. 146 .+-. 170 pmol/min). Captopril decreased average myocardial oxygen consumption (9.7 .+-. 4.1 to 8.2 .+-. 2.7 ml/min, P < 0.01). Given over the long-term (mean 5.5 mo.), captopril decreased the severity of angina from NYHA classification 3.0 .+-. 0.8 to 1.6 .+-. 0.8. Captopril was given in a prospective, randomized, double-blind, placebo-controlled study to 21 patients with stable exercise-induced angina and systolic arterial pressures > 120 mm Hg. Captopril increased exercise time (309 .+-. 137 vs. 374 .+-. 142 s, P < 0.05) without changing anginal threshold (rate-pressure product 17.0 .+-. 6.0 vs. 17.1 .+-. 5.6 .times. 10-3). Captopril evidently decreases mean arterial pressure without causing a reflex increase in myocardial sympathetic tone. By decreasing myocardial oxygen consumption, captopril may prove to be a useful adjunct to the antianginal drug regimens of patients with systolic arterial pressures > 120 mm Hg.


PMID: 3880670

DOI: 10.1161/01.CIR.71.2.317

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