Daytime-Selective Antihypertensive Activity of Celiprolol

Day-activity rhythms of heart rate and blood pressure are thought to be mediated mainly through the sympathetic nervous system and may have greater amplitudes in patients with hypertension owing to increased daytime and largely normal nighttime values. Drug- induced nighttime hypotension in patients...

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Bibliographic Details
Published in:Angiology 1999-10, Vol.50 (10), p.797-803
Main Authors: Cleophas, Ton J., van der Meulen, Jan, van de Luit, Leonie, Zwinderman, Aeilko H.
Format: Article
Language:English
Subjects:
Administration, Oral
Adrenergic beta-Antagonists - administration & dosage
Adrenergic beta-Antagonists - therapeutic use
Adult
Amlodipine - administration & dosage
Amlodipine - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - administration & dosage
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive agents
Antihypertensive Agents - administration & dosage
Antihypertensive Agents - therapeutic use
Biological and medical sciences
Blood Pressure - drug effects
Calcium Channel Blockers - administration & dosage
Calcium Channel Blockers - therapeutic use
Carbazoles - administration & dosage
Carbazoles - therapeutic use
Cardiac Output, Low - chemically induced
Cardiovascular system
Celiprolol - administration & dosage
Celiprolol - therapeutic use
Cerebrovascular Circulation - drug effects
Circadian Rhythm
Cross-Over Studies
Double-Blind Method
Enalapril - administration & dosage
Enalapril - therapeutic use
Female
Heart Rate - drug effects
Humans
Hypertension - drug therapy
Hypertension - physiopathology
Hypotension - chemically induced
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Placebos
Propanolamines - administration & dosage
Propanolamines - therapeutic use
Sympathetic Nervous System - drug effects
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Summary:Day-activity rhythms of heart rate and blood pressure are thought to be mediated mainly through the sympathetic nervous system and may have greater amplitudes in patients with hypertension owing to increased daytime and largely normal nighttime values. Drug- induced nighttime hypotension in patients with chronic hypertension has been associated with the precipitation of cardiac failure and a fall in cerebral flow. The authors examined the effects of a single dose and of a 4-week treatment with different classes of antihy pertensive drugs on ambulatory blood pressure (ABP) in 10 patients with mild hyper tension. Data were assessed by polynomial analysis (Harvard Graphics 3). A single oral dose of enalapril 10 mg, amlodipine 5 mg, carvedilol 25 mg, and celiprolol 200 mg produced a mean reduction of 24-hour ABP compared to placebo of, respectively, 24/11, 11/5, 13/6, and 12/5 mm Hg (p values between < 0.02 and < 0.001). With enalapril, amlodipine, and carvedilol, between-subject variability contributed significantly to the overall variability in the measurements (p values between 0.05 and 0.01 versus zero), whereas with celiprolol this was not so. Although the beta blockers reduced daytime blood pressures similarly to the ACE inhibitor or the calcium channel blocker, they did not reduce nighttime blood pressures. These results were confirmed by an 8-week crossover trial comparing enalapril 10 mg daily with celiprolol 200 mg daily in the same group of patients. The authors conclude (1) that beta blockers produce a more stable reduction of blood pressure in patients with mild hypertension less affected by pressor effects through the sympathetic nervous system; (2) that beta blockers, unlike ACE inhibitors and calcium channel blockers, do not give rise to nighttime hypotension in this category of patients; and (3) that the selective beta blocker celiprolol may even perform better in these respects than the nonselective beta blocker carvedilol.
ISSN:0003-3197
1940-1574
DOI:10.1177/000331979905001003