Koch G
Acta Med Scand. 1986;219(1):17-22. doi: 10.1111/j.0954-6820.1986.tb03270.x.
The hemodynamic responses to 3 different therapeutical regimens: beta-adrenoceptor blockade, calcium inflow inhibition and combined alpha-beta-blockade were evaluated in 3 matched randomized groups of patients with ischemic heart disease and typical exercise-induced angina. The groups consisted of 22, 16 and 15 men, mean age 55-59 years. They were studied at rest and during ischemia-inducing exercise, before and after single oral doses of 100 mg metoprolol, 10 mg nifedipine and 200 mg labetalol. Pressures in the brachial artery and the pulmonary circulation were recorded by means of percutaneously introduced catheters. Cardiac output was determined according to the Fick principle. Metoprolol reduced mean arterial pressures, heart rate and cardiac output. Systemic vascular resistance and left ventricular filling pressure increased. Nifedipine resulted under all conditions in a distinct reduction of systemic vascular resistance and arterial pressures and a slight increase in heart rate and cardiac output. Left ventricular filling pressure was significantly lowered, the more the higher the initial level. The effect of labetalol was similar to that of nifedipine; however, cardiac output was unchanged and heart rate was slightly reduced. Left ventricular filling pressure was significantly lower. It is apparent that suppression of adrenergic stimulation by beta-receptor blockade alone may have adverse hemodynamic effects in ischemic heart disease and prompt further functional deterioration. Conversely, both calcium and combined alpha-beta-receptor blockade tend to improve left ventricular function by lowering both left ventricular preload and total systemic vascular resistance. The results strongly suggest that in patients in whom beta-receptor blockers appear indicated, their adverse hemodynamic effects can be offset by concomitant alpha1-receptor blockade or vasodilation without losing symptomatic efficacy. Combined alpha-beta-receptor blockade has the advantage over calcium antagonists alone to prevent any increase in adrenergic activity and related hyperkinetic response.
在三组匹配的随机分组的缺血性心脏病和典型运动诱发心绞痛患者中，评估了三种不同治疗方案（β-肾上腺素能受体阻滞剂、钙内流抑制和联合α-β阻滞剂）的血流动力学反应。每组分别有22名、16名和15名男性，平均年龄55 - 59岁。在静息状态、缺血诱发运动期间，以及单次口服100毫克美托洛尔、10毫克硝苯地平、200毫克拉贝洛尔前后，对他们进行了研究。通过经皮插入的导管记录肱动脉和肺循环的压力。根据菲克原理测定心输出量。美托洛尔降低平均动脉压、心率和心输出量。全身血管阻力和左心室充盈压升高。硝苯地平在所有情况下均导致全身血管阻力和动脉压明显降低，心率和心输出量略有增加。左心室充盈压显著降低，初始水平越高降低越明显。拉贝洛尔的作用与硝苯地平相似；然而，心输出量不变，心率略有降低。左心室充盈压显著降低。显然，仅通过β受体阻滞剂抑制肾上腺素能刺激在缺血性心脏病中可能产生不利的血流动力学影响，并促使功能进一步恶化。相反，钙阻滞剂和联合α-β受体阻滞剂都倾向于通过降低左心室前负荷和全身血管总阻力来改善左心室功能。结果强烈表明，在似乎需要使用β受体阻滞剂的患者中，其不利的血流动力学影响可通过同时使用α1受体阻滞剂或血管扩张来抵消，而不会丧失症状疗效。联合α-β受体阻滞剂比单独使用钙拮抗剂具有优势，可防止肾上腺素能活性增加及相关的高动力反应。
