Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group.

Abstract

Entry criteria were a positive exercise treadmill test during placebo therapy characterized by 1.0 mm or more ST segment depression and angina pectoris, and six or more episodes of transient ST segment depression of 1.0 mm or more on a 48-hour ambulatory electrocardiogram. One hundred ninety-four patients were screened, 63 were eligible and received randomized therapy, of which 56 patients completed at least two of the four treatment periods and were included in an intent-to-treat analysis. Fifty patients completed all four treatment phases and were included in the protocol-completed analysis. Anti-ischemia efficacy was assessed by 48-hour ambulatory electrocardiographic monitoring, exercise treadmill tests, and anginal diaries. Ninety-four percent of all episodes of ambulatory ischemia were asymptomatic. Compared with placebo, only propranolol was associated with a marked reduction in all manifestations of asymptomatic ischemia during ambulatory electrocardiographic monitoring (2.3 versus 1.0 episodes/24 hr; mean duration of ischemia per 24 hours, 43.6 versus 5.7 minutes; both p <0.0001). Diltiazem's reduction of the frequency of episodes compared with placebo (2.3 versus 1.9 episodes/24 hr) was associated with a trend (p=0.08) in the protocol-completed analysis and with a significant reduction in the intent-to-treat analysis (p=0.03). Nifedipine had no significant effect on any measured variable of ambulatory ischemia. The dosages of medication used may have been excessive for some patients, and a more beneficial effect may have been evident at a lower dose. In contrast to the marked effects of the active agents on ambulatory asymptomatic ischemia, the effects on exercise performance and angina pectoris were slight. The active agents modestly improved treadmill exercise duration time until 1 mm ST segment depression (3%), and only propranolol and diltiazem had significant effects. Only diltiazem significantly prolonged the total exercise time. Anginal frequency was significantly decreased by both propranolol and diltiazem. We conclude that propranolol is effective for treating episodes of asymptomatic ischemia in patients with stable angina and that the magnitude of improvement in ambulatory asymptomatic ischemia is far greater than the improvement in exercise performance and angina symptoms.

Comparative Effects of Azelnidipine and Amlodipine on Myocardial Function and Mortality After Ischemia/Reperfusion in Dogs

“…Nifedipine, a short-acting dihydropyridine calcium antagonist, has been reported to cause reflex sympathetic stimulation and tachycardia when blood pressure decreases after the administration of the drug (14,15). Amlodipine, a long acting calcium antagonist, is characterized by a higher vascular selectivity and smaller positive inotropic effect; therefore, amlodipine is recommended for patients with hypertension and angina (8).…”

Microwave assisted synthesis and biological evaluation of a series of 1,5-benzothiazepines as potential cytotoxic and antimicrobial agents

“…A number of biological activities have also been associated with it, such as antianginal [8], antihypertensive [9], antiischemic [10], antiarrhythmic [11], platelet aggregation inhibitor [12], vasodilator [13], calcium channel blocker [14], calcium channel antagonist [15] and calcium channel activator [16]. In recent past, under the frame work of "Green Chemistry" microwave-assisted synthesis is one of the non-conventional techniques used in laboratory for the synthesis of organic compounds.…”

Prevalence and Prognosis of Asymptomatic Coronary Artery Disease in Patients With Abdominal Aortic Aneurysm and Minor or No Perioperative Risks

“…[17][18][19][20][21][22][23][24][25][26] As for medication, Juul-Moller et al, reported the efficacy of aspirin in patients with stable AP, 17 and Pepine et al showed the efficacy of atenolol, even in patients with silent myocardial ischemia. 19 Many recent clinical trials support the effectiveness of statins.…”