Combined therapy with beta-adrenergic blockers and calcium-antagonists in patients with ischemic heart disease

Although the beta-adrenergic blocking agents alone are effective in most patients with stable angina pectoris, the addition of a calcium-antagonist may be beneficial in those with especially limiting symptoms. Such combination therapy causes a marked reduction in myocardial oxygen requirements by diminishing heart rate, systolic arterial pressure, and left ventricular contractility. At the same time, myocardial oxygen supply is maintained or augmented because of calcium-blocker-induced coronary arterial dilatation and augmentation of collateral blood flow. However, in some patients, the concomitant administration of a beta-blocker and a calcium-blocker may lead to serious adverse effects. This may be especially true when a beta-blocker is given in combination with verapamil, since both agents depress left ventricular performance and atrioventricular conduction. Preliminary studies have demonstrated that a combination of nifedipine-propranolol as well as verapamil-propranolol is more effectivethan either agent alone in the therapy of individuals with stable angina.