Differential actions of atenolol and celiprolol on cardiac performance in ischemic heart disease.

The therapeutic relevance of differences between beta-adrenoceptor antagonists, related to their ancillary pharmacological properties, is debated. Celiprolol is a novel cardioselective beta-blocking agent with attributed cardio-stimulating properties. Its hemodynamic profile was compared with that of atenolol (cardioselective; no ISA) in a comparative dose-response study of 24 patients with angiographically documented coronary artery disease. Following a stable control period four i.v. boluses of equivalent beta-blocking doses of atenolol (1, 1, 2, and 4 mg) or celiprolol (1, 1, 2, and 4 mg) were administered, and hemodynamics and left ventricular ejection fraction were determined. The comparative actions of the two drugs on the hemodynamics of exercise-induced angina were compared by exercise testing in the control state and following the maximum cumulative dose of each drug. At rest, atenolol reduced heart rate, cardiac index, and left ventricular ejection fraction (EF); systemic vascular resistance index increased without change in systemic arterial or pulmonary artery occluded pressures. Celiprolol increased cardiac index and ejection fraction without change in other variables. During exercise both drugs reduced cardiac index and heart rate; neither altered the exercise EF. The cardiac function curve, relating cardiac index to left ventricular end-diastolic pressure, was significantly depressed by atenolol but was elevated at rest by celiprolol. Thus these studies demonstrated hemodynamic differences between atenolol and celiprolol, presumably related to the ancillary properties of the latter. The relevance of such differences to the therapy of patients with coronary artery disease deserves further examination.