Preload or afterload reduction: which is more beneficial for patients with ischemic heart disease?

We studied the acute hemodynamic effects of molsidomine, a selective preload reducing agent, and nifedipine, a selective afterload reducing agent. Thirty-two patients with stable angina pectoris and angiographically significant coronary artery disease were randomized into two groups: group A patients received 4 mg of molsidomine, and group B patients received 20 mg of nifedipine orally. Molsidomine was associated with a significant reduction of the left ventricular end-diastolic pressure and an increase in Vcf. Nifedipine caused a significant reduction of the mean arterial pressure and an increase of the heart rate. Hemodynamic parameters associated with chronic exertional angina pectoris in patients with angiographically significant coronary artery disease improved more with a preload reducing agent, like molsidomine.