Hemodynamic Effects of Intravenous Nisoldipine and Nitroglycerin in Patients with Coronary Heart Disease
In a biometrically planned, controlled group comparison study comprising 12 patients with angiographically verified coronary heart disease, we determined the effects of a single IV dose of nisoldipine ( 6 µg/kg body weight) on hemodynamic parameters at rest and during bicycle exercise and compared these results with those recorded after a single IV dose of nitroglycerin (0.5 mg). Informed consent was obtained, and each patient underwent conventional cardiac catheterization with coronary angiography and complete hemodynamic studies in the pulmonary vascular bed and systemic circulation. After a stabilization period and determination of baseline hemodynamic parameters for purposes of profile analysis, a standardized bicycle exercise test was performed until chest pain developed or characteristic ST-segment depression was documented. Study parameters were recorded with repeat determinations after 30 min. Following injection of the test medication, study parameters were again recorded at baseline, after bicycle exercise, and after recovery.
Statistical evaluation demonstrated no significant differences between the two groups with regard to demographic parameters as well as total peripheral resistance, cardiac index, derived parameters, and mean pulmonary artery pressure at baseline. Intravenous administration of a single dose of nisoldipine (6µg/kg body weight over 3 min) was followed by a significant decrease in total peripheral resistance and significant increases in cardiac index, stroke volume index, and other derived parameters. Opposite effects were found after administration of nitroglycerin. Analysis using a model of covariance reveals a highly significant difference in therapeutic effect for these parameters between the two interventions. This reflects the different sites of action of the two drugs with corresponding implications for their use in treating patients with coronary heart disease.
KeywordsCatheter Glycerin Depression Covariance Nitroglycerin
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