Adverse effects were mild and most occurred during the placebo phase. Two patients complained of tiredness and mild ankle swelling, and another had headaches while taking atenolol.
Blood Pressure and Pulse Rates
All diastolic blood pressures fell significantly during both celiprolol and atenolol treatment, but systolic blood pressure taken with the patient in a supine position was reduced only by atenolol therapy (Table 2). Mean diastolic blood pressure values during the two treatment periods were similar. Five patients who were taking celiprolol and four who were taking atenolol achieved ideal diastolic blood pressure values (below 90 mm Hg or a reduction of more than 10 mm Hg).
There was a small fall in pulse rate in both the supine and erect positions when a patient who had been receiving placebo was switched to atenolol. No pulse rate change occurred during celiprolol therapy.
Acute Single-Dose Drug Challenge
Following the single-dose challenge with atenolol, the FEVx, FVC and PEF fell progressively during 3 h, and were significantly lower at the end of the 3 h (p<0.01), but improved significantly (p<0.05) to prechallenge levels after treatment with salbutamol inhaler (Fig 2). After celiprolol therapy, the FEVj, FVC and PEF remained unchanged, yet responsiveness to salbutamol was retained. No deterioration in spiro-metric parameters was seen when placebo was given.
The single-dose response following two weeks of maintenance beta-blocker therapy was similar to that seen when placebo was given.
Long-Term Control of Asthma
Day-to-day control of asthma was no different with either atenolol or celiprolol therapy when compared with placebo therapy (Fig 3, Table 3). This was true for cough and asthma symptom scores, mean peak flow measurements taken twice daily and frequency of inhaler use. Seven patients regularly used a bron-chodilator (Table 1). add comment
Table 2—Effect of Celiprolol Compared with Atenolol and Placebo on Blood Pressure of Ten Asthmatic Patients with Hypertension after 4 weeks cf Therapy
|Supine Position||Erect Position||Pulse Rate (beats per minute)|
|Systolic Blood Pressure (mm Hg)||Diastolic Blood Pressure (mm Hg)||Systolic Blood Pressure (mm Hg)||Diastolic Blood Pressure (mm Hg)||SupinePosition||ErectPosition|
|Placebo||160 ±5||100±1||147 ±4||101 ±2||78.0 ±3.7||81.6±3.7|
|Celiprolol||154 ±7||93 ±4$||146 ±7||95 ± 4||||79.6 ±2.8||81.2±3.3|
|Washout**||157 ±7||98±5||151 ±5||99±4|
|Atenolol||151 ±5t||94±3§||144 ±4||94 ±211||67.8 ±2.7||73.2 ±2.2|
Table 3—Effects of Celiprolol and Atenolol During Chronic Therapy on Symptoms and Inhaler Use in Asthmatic Subjects During Chronic Therapy
|Placebo||1.9 ±0.16||1.5 ±0.13|
|Atenolol||1.8 ±0.16||1.9 ±0.24|
Figure 2. Acute single-dose challenge with beta-blocker or placebo.
Figure 3. Effects of celiprolol and atenolol during chronic therapy on morning and evening PEF (means ± SEM). Differences between placebo, celiprolol and atenolol were not significant.