Beta-Blockers and Calcium Antagonists: Synergistic Effects

  • L.-G. Ekelund
Conference paper


Calcium-blockers dilatate the peripheral vessels and thereby decrease the blood pressure. The decrease in blood pressure induces a reflex increase in heart rate which could counteract the decrease in blood pressure and diminish the decrease in rate pressure product. Therefore it is logical to combine a Ca2+-blocker with a beta-blocker when treating patients with coronary insufficiency or hypertension. Nifedipine could safely be combined with a beta-blocker. In a study of 21 patients with angina pectoris the addition of a beta-blocker to the calcium-blocker nifedipine further increased the working capacity with 21%. The same synergistic effect was also obtained in a new double-blind trial after six months continuous treatment with nifedipine.

In a study of 12 patients with essential hypertension nifedipine 10 mg t.i.d. alone decreased the resting blood pressure with 20 mmHg. The addition of metoprolol 100 mg b.i.d. gave a decrease in resting blood pressure with 37 mmHg. A synergistic effect was also obtained during exercise.

The few pharmacological side-effects, flushing, headache and palpitations, induced by nifedipine were completely abolished after addition of a beta-blocker.


Calcium Antagonist Plasma Renin Activity Exercise Tolerance Sympathetic Tone Coronary Insufficiency 
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  1. 1.
    Andersson KE, Ekelund L-G, Johansson BW, Landmark K (1978) Calciumantagonists (CA-blockers). Pharmacological, physiological and clinical aspects. Proc from a meeting in Vedbaeck, Denmark, 1977. Acta Pharm Toxicol 43 [Suppl 1]Google Scholar
  2. 2.
    Aoki K, Kondo S, Mochizuki A, Yoshida T, Kato S, Kato K, Takikawa K (1978) Anti-hypertensive effect of cardiovascular Ca2+-antagonists in hypertensive patients in the absence and presence of beta-adrenergic blockade. Am Heart J 96: 218PubMedCrossRefGoogle Scholar
  3. 3.
    Bevegârd S, Flygt G, Orö L (to be published) Combination treatment in angina pectoris. Addition of nifedipine or isosorbidedinitrate to metoprolol in a double-blind studyGoogle Scholar
  4. 4.
    Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2: 92PubMedGoogle Scholar
  5. 5.
    Ekelund L-G, Orö L (1979) Antianginal efficiency of Nifedipine with and without a beta-blocker, studied with exercise test. A double-blind randomized subacute study. Clin Cardiol 2: 203Google Scholar
  6. 6.
    Ekelund L-G, Ekelund C, Rössner S (to be published) Antihypertensive effects of a Calcium-blocker nifedipine alone and in combination with metoprolol. A sub-acute study with exercise testsGoogle Scholar
  7. 7.
    Ellrodt G, Chew CYC, Singh BN (1980) Therapeutic implications of slow-channel blockade in cardiocirculatory disorder. Circulation 62: 669PubMedGoogle Scholar
  8. 8.
    Guazzi M, Fiorentini C, Olivari MT, Bartorelli A, Necchi G, Polese A (1980) Short- and long-term efficacy of a Calcium-antagonistic agent ( Nifedipine) combined with Methyldopa in the treatment of severe hypertension. Circulation 61: 913Google Scholar
  9. 9.
    Kenmure ACF, Scruton JH (1979) A double-blind controlled trial of the anti-anginal efficacy of Nifedipine compared with Propranolol. Br J Clin Pract 33: 49PubMedGoogle Scholar
  10. 10.
    Kuwajima I, Ueda K, Kamata C, Matsushita S, Kuramoto K, Murakami M, Hada Y (1978) A study on the effects of Nifedipine in hypertensive crises and severe hypertension. Jpn Heart J 19: 455PubMedCrossRefGoogle Scholar
  11. 11.
    Lederballe Pedersen O, Mikkelsen E (1978) Acute and chronic effects of Nifedipine in arterial hypertension. Eur J Clin Pharmacol 14: 375CrossRefGoogle Scholar
  12. 12.
    Lederballe Pedersen O, Mikkelsen E, Christensen NJ, Kornerup HJ, Pedersen EB (1979) Effect of Nifedipine on plasma renin, aldosterone and catecholamines in arterial hypertension. Eur J Clin Pharmacol 15: 235CrossRefGoogle Scholar
  13. 13.
    Lederballe Pedersen O, Christensen CK, Mikkelsen E, Rämsch KD (1980) Relationship between the antihypertensive effect and steady-state plasma concentration of Nifedipine given alone or in combination with a beta-adrenoceptor blocking agent. Eur J Clin Pharmacol 18: 287CrossRefGoogle Scholar
  14. 14.
    Lynch P, Dargie H, Krikler S, Krikler D (1980) Objective assessment of antianginal treatment; a double-blind comparison of propranolol, nifedipine, and their combination. Br Med J 281: 184PubMedCrossRefGoogle Scholar
  15. 15.
    Nayler WG (1980) Calcium antagonists. Eur Heart J 1: 225PubMedGoogle Scholar
  16. 16.
    Olivari MT, Bartorelli C, Polese A, Fiorentini C, Moruzzi P, Guazzi MD (1979) Treatment of hypertension with Nifedipine, a Calcium antagonistic agent. Circulation 59: 1956Google Scholar
  17. 17.
    Opie LH (1980) Drugs and the Heart. III. Calcium antagonists. Lancet 12: 806CrossRefGoogle Scholar
  18. 18.
    Rowland E, Evans T, Krikler D (1979) Effect of nifedipine on atrioventricular conduction as compared with verapamil. Intracardiac electrophysiological study. Br Heart J 42: 124Google Scholar
  19. 19.
    Schmutzler H, Dorow P (1980) The combined use of acebutolol and nifedipine in patients with coronary heart disease. In: Roskamm H, Graefe K-H (eds) Advances in β-blocker therapy. Excerpta Medica, Amsterdam-Oxford-PrincetonGoogle Scholar
  20. 20.
    Stone PH, Antman EM, Miller JE, Braunwald E (1980) Calcium channel blocking agents in the treatment of cardiovascular disorders. Part I Hemodynamic effects and clinical applications. Ann Intern Med 93: 886Google Scholar
  21. 21.
    Thibonnier M, Bonnet F, Corvol P (1980) Antihypertensive effect of fractionated sublingual administration of Nifedipine in moderate essential hypertension. Eur J Clin Pharmacol 17: 161PubMedCrossRefGoogle Scholar
  22. 22.
    Vuori MI, Hämäläinen H, Pietilà TJ, Kallio VI (to be published) Assessment of exercise tolerance of cardiac patients by bicycle, tread-mill, and tread-mille plus isometric exercise with and without nifedipineGoogle Scholar

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© Springer-Verlag, Berlin, Heidelberg 1981

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  • L.-G. Ekelund

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