A double-blind randomized trial of propranolol and verapamil in the treatment of effort angina.

Sadick, Norman; Tan, Augustine H. H.; Fletcher, Peter; Morris, Jonathan; Kelly, D T

doi:10.1161/01.cir.66.3.574

Cited by 40 publications

(5 citation statements)

References 25 publications

(3 reference statements)

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“…We observed a wide inter-and intraindividual variation in plasma concentrations of verapamil, with a range which resembled that reported in other studies.8 17 pamil concentrations in patients with coronary heart disease. We observed a modest rise in mean plasma concentrations of verapamil and nor-verapamil during combination treatment, which was not statistically significant.…”

Section: Discussionsupporting

confidence: 88%

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

Findlay¹,

MacLeod²,

Gillen³

et al. 1987

Heart

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SUMMARY The efficacy and effect on cardiac function of verapamil 120 mg three times a day and atenolol 100mg once a day, singly and in combination, were evaluated in 15 patients with angina pectoris. While they were on the combination treatment four patients withdrew from the study. Episodes of angina pectoris and glyceryl trinitrate consumption were significantly reduced only on the combination. On the combination only four patients developed evidence of ischaemia during exercise compared with seven on verapamil and ten on atenolol. ST segment depression at peak exercise, assessed by 16 point precordial mapping, was reduced by all active treatments from 7 1 on placebo to 2-7, 0-9, and 0-6 mm on atenolol, verapamil, and the combination respectively. Mean left ventricular ejection fraction fell significantly from 60% on placebo to 53% on the combination but was unchanged on verapamil and atenolol.

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Section: Discussionsupporting

confidence: 88%

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

Findlay¹,

MacLeod²,

Gillen³

et al. 1987

Heart

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“…It appeared that verapamil 360 mg/day was equiactive to propranolol 300 mg/day (Sandler et al, 1968; Livesley et al, 1973; Johnson et al, 1981; Leon et al, 1981; Frishman et al, 1982; Sadick et al, 1982; Tan et al, 1982; Findlay et al, 1987). Since there is a dose-dependency for both agents, it is obvious that the superiority of one agent against the other cannot be estimated by comparing a single dose of each drug.…”

Section: Key Information About Clinical Usefulness Of Ccbsmentioning

confidence: 99%

Discovery and Development of Calcium Channel Blockers

2017

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In the mid 1960s, experimental work on molecules under screening as coronary dilators allowed the discovery of the mechanism of calcium entry blockade by drugs later named calcium channel blockers. This paper summarizes scientific research on these small molecules interacting directly with L-type voltage-operated calcium channels. It also reports on experimental approaches translated into understanding of their therapeutic actions. The importance of calcium in muscle contraction was discovered by Sidney Ringer who reported this fact in 1883. Interest in the intracellular role of calcium arose 60 years later out of Kamada (Japan) and Heibrunn (USA) experiments in the early 1940s. Studies on pharmacology of calcium function were initiated in the mid 1960s and their therapeutic applications globally occurred in the the 1980s. The first part of this report deals with basic pharmacology in the cardiovascular system particularly in isolated arteries. In the section entitled from calcium antagonists to calcium channel blockers, it is recalled that drugs of a series of diphenylpiperazines screened in vivo on coronary bed precontracted by angiotensin were initially named calcium antagonists on the basis of their effect in depolarized arteries contracted by calcium. Studies on arteries contracted by catecholamines showed that the vasorelaxation resulted from blockade of calcium entry. Radiochemical and electrophysiological studies performed with dihydropyridines allowed their cellular targets to be identified with L-type voltage-operated calcium channels. The modulated receptor theory helped the understanding of their variation in affinity dependent on arterial cell membrane potential and promoted the terminology calcium channel blocker (CCB) of which the various chemical families are introduced in the paper. In the section entitled tissue selectivity of CCBs, it is shown that characteristics of the drug, properties of the tissue, and of the stimuli are important factors of their action. The high sensitivity of hypertensive animals is explained by the partial depolarization of their arteries. It is noted that they are arteriolar dilators and that they cannot be simply considered as vasodilators. The second part of this report provides key information about clinical usefulness of CCBs. A section is devoted to the controversy on their safety closed by the Allhat trial (2002). Sections are dedicated to their effect in cardiac ischemia, in cardiac arrhythmias, in atherosclerosis, in hypertension, and its complications. CCBs appear as the most commonly used for the treatment of cardiovascular diseases. As far as hypertension is concerned, globally the prevalence in adults aged 25 years and over was around 40% in 2008. Usefulness of CCBs is discussed on the basis of large clinical trials. At therapeutic dosage, they reduce the elevated blood pressure of hypertensive patients but don't change blood pressure of normotensive subjects, as was observed in animals. Those active on both L- and T-type channels are efficient in nephropat...

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“…However, since exercise capacity is increased with 0-blockade, ST response may be observed at a later stage of exercise with decreased (Beller et al, 1984;Jennings et al, 1980;Sadick et al, 1982;Thadani and Parker, 1979) or unchanged (Frishman et al, 1982) magnitude of ST deviation. @blockade has also been claimed to eliminate false positive responses without a decrease in true negative EECGs (Marcomichelakis et al, 1980).…”

Section: Effect Of Digitalis and 0-blockade On Eecgmentioning

confidence: 99%

“…Exclusion of these subjects from the series will lead to selective patient material, evidently excluding the most severely symptomatic individuals. It is still controversial as to what extent digoxin (Adair et al, 1972;Bartel et al, 1974;Bermen et al, 1978;Frick et al, 1972;Kawai and Hultgren, 1964 Chaitman et al, 1984;Frishman et al, 1982;Gianelly et al, 1969;Jennings et al, 1980;Marcomichelakis et al, 1980;Sadick et al, 1982;Thadani and Parker, 1979), or concurrent use of these drugs (Frick et al, 1972;LeWinter et al, 1977) modify the exercise electrocardiographic (EECG) response.…”

Section: Introductionmentioning

confidence: 99%

Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography

Pellinen

Virtanen

Valle

et al. 1986

Clinical Cardiology

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Summary:The results of exercise electrocardiography were studied in a random sample of 317 subjects with clinical suspicion of coronary artery disease. In 278 patients with coronary artery disease the rate of false negative tests was 18% with and 12% without previous myocardial infarction. If ST elevation was considered a negative response, the corresponding values were 25% and 13%, respectively, p

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A double-blind randomized trial of propranolol and verapamil in the treatment of effort angina.

Cited by 40 publications

References 25 publications

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

Discovery and Development of Calcium Channel Blockers

Studies on ergometer exercise testing II. Effect of previous myocardial infarction, digoxin, and β‐blockade on exercise electrocardiography

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