A COMPARISON OF THE ACUTE HEMODYNAMIC-EFFECTS OF NISOLDIPINE AND NIFEDIPINE DURING TREATMENT WITH ATENOLOL IN PATIENTS WITH CORONARY-ARTERY DISEASE

1 The acute haemodynamic effects of intravenous nisoldipine (1, 2, 4 mug kg-1) and nifedipine (2.5, 5, 10 mug kg-1) were compared in a randomised, within-patient cross-over study. Fifteen male patients with stable angina pectoris treated with atenolol were studied after undergoing routine cardiac catheterisation. 2 Nisoldipine caused a dose-related fall in systemic vascular resistance (maximum 22%) associated with an increase in heart rate and cardiac index (18%) and a fall in mean arterial pressure (7%). 3 By contrast, nifedipine was associated with a significant increase in heart rate but systemic vascular resistance, cardiac index and mean arterial pressure remained unaltered. 4 At doses with equivalent effects on heart rate (2 mug kg-1 nisoldipine; 10 mug kg-1 nifedipine) acute dosing with nisoldipine caused a significantly greater fall in systemic vascular resistance and increase in cardiac index, whilst nifedipine caused a greater reduction in stroke volume index and left ventricular stroke work index. 5 The results suggest that, when combined with atenolol, acute dosing with nisoldipine may have a more complementary haemodynamic profile than nifedipine. The implications of this finding for chronic oral dosing in patients with impaired left ventricular function should be evaluated.