4 research outputs found
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Calcium-channel blockers for combined angina pectoris and systemic hypertension
Calcium-channel blockers have been successfully used in the treatment of angina of effort and systemic hypertension. Many patients present with concomitant angina pectoris and hypertension. Controlled clinical trials demonstrate that the calcium-channel blockers are safe and effective as monotherapy in the treatment of these patients, and that their use compares favorably with that of propranplol. The effectiveness of these agents in hypertension appears to be primarily due to their ability to induce systemic vasodilation. Calcium-channel blockers have several therapeutic effects in angina pectoris. Beneficial actions on the major determinants of oxygen consumption, i.e. heart rate, blood pressure and contractility, are generally seen. The potent coronary vasodilating actions of these agents allow for increased coronary blood flow. Improvements in ventricular compliance, regression of left ventricular hypertrophy and cardioprotection appear to be additional effects of the calcium-channel blockers; their contribution to the drugs' overall therapeutic efficacy is presently being evaluated. Calcium-channel blockers are a welcome addition to drug regimens available for the management of patients with coexisting angina pectoris and hypertension
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Comparison of diltiazem and nifedipine for both angina pectoris and systemic hypertension
In a randomized, double-blind, placebo-controlled crossover trial, diltiazem and nifedipine were compared in 10 patients with stable angina pectoris and mild to moderate hypertension (supine diastolic blood pressure ≥90 mm Hg). Patients received placebo for 2 weeks, then increasing doses of diltiazem (90 to 360 mg/day) or nifedipine (30 to 120 mg/day) in 3 daily divided doses over 2 weeks, followed by 1 week of therapy at the maximal dose, a 1-week placebo “washout,” then crossover to the other drug. Heart rate and blood pressure at rest and during exercise, anginal frequency, nitroglycerin consumption and treadmill exercise tolerance were assessed.
Compared with placebo, anginal frequency and nitroglycerin consumption were reduced with both diltiazem and nifedipine (p < 0.01) and exercise tolerance was increased with both drugs (p < 0.01). Standing blood pressure at rest was reduced by diltiazem and nifedipine (
146.6 ± 11.4
97.7 ± 5.3
mm Hg at placebo, baseline reduced to
129.6 ± 15.2
79.5 ± 13.7
mm Hg with diltiazem, and to
122.2 ± 9.9
82.0 ± 7.1
with nifedipine, p < 0.01 for both). Compared with placebo, diltiazem and nifedipine also reduced exercise diastolic blood pressure (p < 0.01), but not systolic blood pressure. Diltiazem lowered the heart rate at rest from 88.5 ± 14.4 beats/min at placebo baseline to 79.7 ± 17.9 beats/min (p < 0.01); the heart rate with diltiazem was 11 beats/min lower than that with nifedipine (p < 0.05). Both diltiazem and nifedipine had similar effects on the heart rate-blood pressure product at rest and during exercise. Both drugs were well tolerated. Thus, diltiazem and nifedipine appear equally effective and safe in patients with both hypertension and angina pectoris by relieving angina, improving exercise tolerance and reducing elevated blood pressure
Combination propranolol and bepridil therapy in stable angina pectoris
The safety and efficacy of bepridil plus propranolol therapy were investigated in a placebo-controlled, parallel-design, double-blind trial in 56 patients who were not responding to propranolol alone. Patients entering the study were receiving an average propranolol dosage of 131 mg/day (range 20 to 240). For the first 2 weeks of the study they were given placebo in addition to their propranolol dose, and then were randomized to receive continued placebo plus propranolol or bepridil plus propranolol therapy. The bepridil dosage was adjusted over the 8 weeks of active treatment to an average of 273 mg/day (range 200 to 400). The double-blind treatment period was followed by a 3-week washout period during which all patients received propranolol and placebo. The effects of treatment on the frequency of angina attacks, nitroglycerin consumption, exercise performance (treadmill-modified Bruce protocol) and Holter electrocardiogram (ECG) were assessed. Propranolol and bepridil plasma levels also were obtained. Improved antianginal efficacy and reduced nitroglycerin consumption were noted when bepridil was added to propranolol (p \u3c 0.01). During 8 weeks of combination treatment, exercise tolerance increased 1.0 ± 1.2 minutes from a baseline of 7.3 ± 2.2 with bepridil plus propranolol compared with an increase of 0.02 ± 1.3 minutes from a baseline of 7.6 ± 2.9 with placebo plus propranolol (p \u3c 0.01). With bepridil plus propranolol, there were also increases in exercise time to onset of angina (p \u3c 0.04), exercise time to 1-mm electrocardiographic ST-segment depression (p \u3c 0.06) and total work (p \u3c 0.03) compared with placebo plus propranolol therapy. Resting heart rate was reduced a maximum of 2 beats/min with combination treatment compared with propranolol alone, and no differences in blood pressure between treatment groups were observed. There were no clinically significant rhythm changes on Holter ECG with combination treatment, and bepridil treatment had no effect on plasma propranolol levels. Bepridil did prolong the QTc interval on resting ECG by a mean of 37 ± 39 millisecond. Adverse effects were mild with bepridil plus propranolol and greater in frequency than those with placebo plus propranolol. With cessation of bepridil, patients returned toward the angina frequency and exercise tolerance levels seen at baseline with propranolol alone. The addition of bepridil to propranolol provided safe and effective antianginal therapy in patients whose angina was not controlled by propranolol alone. © 1985