Beta-Blockers and Calcium Antagonists: Synergistic Effects
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.
KeywordsCalcium Antagonist Plasma Renin Activity Exercise Tolerance Sympathetic Tone Coronary Insufficiency
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