THE INFLUENCE OF NICARDIPINE ON LEFT-VENTRICULAR HEMODYNAMICS AND COMPLIANCE IN PATIENTS WITH CORONARY HEART-DISEASE

The hemodynamic effects of nicardipine were studied in 10 normotensive patients (nine men, one woman; age 43-70 years, mean 56 years) and five patients with mild to moderate hypertension (four men, one woman; age 46-72 years, mean 62.8 years); in all patients coronary heart disease was confirmed by angiography. Hemodynamic parameters were determined before and after intravenous administration of nicardipine in cumulative doses of 2.5, 7.5, and 12.5 mg for 10 min each. Nicardipine significantly reduced systolic aortic pressure, diastolic aortic pressure, and mean aortic pressure in normotensive patients [139 +/- 8.7 vs. 114 +/- 9.2 mm Hg (p < 0.001), 73 +/- 9.1 vs. 56 +/- 7.9 mm Hg (p < 0.001), 97 +/- 7.8 vs. 78 +/- 7.9 mm Hg (p < 0.001), respectively] and in hypertensive patients [166 +/- 7.4 vs. 128 +/- 8.6 mm Hg (p < 0.001), 83 +/- 9.4 vs. 56 +/- 10.9 mm Hg (p < 0.001), 110 +/- 15.5 vs. 78 +/- 12.0 mm Hg (p < 0.001, respectively]. Systemic vascular resistance was decreased significantly in hypertensive patients [1,363 +/- 188 vs. 707 +/- 137.7 dyn sec cm-5 (p < 0.001)] and in normotensive patients [1,110 +/- 225.3 vs. 682 +/- 92.4 dyn sec cm-5 (p < 0.001)]. Heart rate increased from 68 +/- 6.8 to 83 +/- 11.4 beats/min (p < 0.001) in normotensive patients but the increase from 72 +/- 14.7 to 80 +/- 14.2 beats/min in hypertensive patients was not significant. Mean pulmonary artery pressure did not change significantly in hypertensive patients and increased slightly in normotensive patients. Pulmonary wedge pressure remained almost constant. Stroke volume index increased in normotensive patients from 50.5 +/- 7.4 to 56 +/- 3.9 ml/m2 (p < 0.01) and in hypertensive patients from 48 +/- 11 to 60 +/- 10 ml/m2 (p < 0.06), dp/dt(max) did not change in hypertensive patients and showed a slight increase in normotensive patients [1,502 +/- 226.3 vs. 1,884 +/- 402.7 mm Hg/s (p < 0.001)]. Improvement of wall motion abnormalities was observed in five normotensive patients and in two hypertensive patients. The preliminary results of Doppler echocardiographically assessed diastolic function measured in five patients did not show a uniform tendency. Side effects were observed in three patients (angina pectoris in one, headache in two). It is concluded that nicardipine provides potent vasodilator effects and can improve left ventricular function in hypertensive and normotensive patients with coronary heart disease.