Long-term efficacy of diltiazem in chronic stable angina associated with atherosclerosis: Effect on treadmill exercise

Pool, Peter E.; Seagren, Shirley C.

doi:10.1016/s0002-9149(82)80014-3

Cited by 54 publications

(6 citation statements)

References 8 publications

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“…The anti-ischaemic efficacy of diltiazem has been demonstrated in numerous randomized controlled studies both in stable [2,11,12] and unstable [13,14] angina pectoris. Improved exercise tolerance in patients suffering from effort-induced angina pectoris is attributed to the potent vasodilating properties of diltiazem, which lead to decreases in afterload, in the double product and in some instances to improved coronary flow [3].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the 200–300 mg sustained release formulation of diltiazem administered once daily in patients with stable angina

Trimarco

Radzik²,

Mieghem³

et al. 1995

Eur J Clin Pharmacol

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The aim of this multicentre randomised double blind study was to compare the efficacy and safety of the 200-300 mg sustained release diltiazem formulation administered once daily (200-300 SR) with standard diltiazem (D) given three or four times daily to patients with stable angina. Patients aged 59 years, with a reproducible exercise test on placebo, were randomised to 4 weeks of treatment with 200-300 SR (n = 70) or D (n = 74). The initial dosage was 200 mg in the 200-300 SR group and 60 mg t.i.d. in the D group, increased to 300 mg once daily or 60 mg q.i.d., respectively, if ergometric parameters, which were always measured at the end of the dosing period, had not improved after two weeks. After 4 weeks of treatment, the antianginal efficacy at rest was comparable in the 200-300 SR and the D group; there was a prolongation of the total duration of exertion of 14% and 18% respectively (P < 0.01 vs placebo for both groups with no intergroup difference). A dose-effect relation was found with both formulations. The 200-300 SR formulation gave full 24 hour anti-ischaemic protection when administered once daily. Its efficacy and safety were comparable to those of standard diltiazem t.i.d. or q.i.d. in patients with stable angina. The once daily administration should improve treatment compliance.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the 200–300 mg sustained release formulation of diltiazem administered once daily in patients with stable angina

Trimarco

Radzik²,

Mieghem³

et al. 1995

Eur J Clin Pharmacol

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“…In patients with stable effort angina, an increase in exercise tolerance and a negative chronotropic effect of diltiazem are more evident at higher doses,1>'6 but the effects of doses larger than 240 mg/day (or 60 mg four times daily) have not been previously studied. [17][18][19][20] The specific objective of this study was to compare the effects of 90 mg diltiazem four times daily, 60 mg propranolol four times daily, and the combination of diltiazem and propranolol with those of placebo on exercise performance, myocardial ischemia, and left ventricular function in patients with stable exertional angina. Secondary objectives were to determine if there were any differences in the antianginal mechanisms of the drugs and to assess the short-term safety of high-dose diltiazem, both alone and in combination with propranolol.…”

mentioning

confidence: 99%

The effect of diltiazem and propranolol, alone and in combination, on exercise performance and left ventricular function in patients with stable effort angina: a double-blind, randomized, and placebo-controlled study.

Hung¹,

Lamb²,

Connolly³

et al. 1983

Circulation

152

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The effects of oral diltiazem and propranolol, alone and in combination, were compared with those of placebo in 12 patients with stable effort angina. Patients performed symptom-limited, multistage, upright bicycle ergometric exercise while undergoing equilibrium-gated radionuclide angiographic examination after 2 week periods of 90 mg diltiazem four times daily, 60 mg propranolol four times daily, a combination of 90 mg diltiazem and 60 mg propranolol four times daily, and placebo. All drugs were given double blind and in randomized order. Diltiazem, propranolol, and the combination significantly increased exercise duration compared with placebo (562 + 149, 525 + 115, and 549 121, vs 430 + 132 sec); the drugs also increased time to onset of angina pectoris and ischemic ( 1 mm) ST segment depression (all p < .05). Compared with after placebo, heart rate and rate-pressure product at a fixed submaximal workload were decreased after diltiazem (both p < .05), but were unchanged at peak effort. Heart rate and rate-pressure product at both submaximal and peak effort were decreased by propranolol (all p < .001) and were decreased further by the combination of diltiazem and propranolol (all p < .05 vs propranolol). Diltiazem and the combination of diltiazem and propranolol decreased maximal exercise ST segment depression (both p < .01 vs placebo). The mean exercise left ventricular ejection fraction was higher in patients on diltiazem than in those on placebo, propranolol, or the combination of diltiazem and propranolol (all p < .05). Adverse side effects severe enough to require dosage reduction (severe sinus bradycardia or orthostatic hypotension) occurred in four patients on combination therapy. High-dose diltiazem alone appears to be as effective as or more effective than moderate-dose propranolol or the combination of diltiazem and propranolol in improving exercise tolerance, myocardial ischemia, and left ventricular function in patients with stable effort angina.Circulation 68, No. 3, 560-567, 1983. CALCIUM-CHANNEL BLOCKERS provide a promising alternative to /8-blockers for the management of patients with exertional angina and fixed coronary artery disease. These drugs can reduce myocardial oxygen demand by decreasing systemic vascular resistance, and in some cases cardiac contractility and heart rate, while producing an increase in coronary blood flow through dilation of large coronary vessels. 1

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“…Verapamil and diltiazem are two of the three calciumchannel blocking agents that have recently become available in the United States for the treatment of patients with angina. Several studies have documented short-term benefits of verapamil (Bala Subramanian et al, 1980;Brodsky ef al., 1982;Frishman ef al., 1982;Leon et al, 1981;Pine et al, 1982;Tan et al, 1982) and diltiazem (Bala Subramanian et al, 1983;Hossack et al, 1982;Lindenberg et al, 1983;Pool and Seagren, 1982;Starling et al, 1982;Strauss ef al., 1982), especially using the higher dosages, but few investigations have been conducted to show that these short-term benefits are sustained during long periods of drug administration.…”

Section: Discussionmentioning

confidence: 99%

“…af., 1984;Pool and Seagren, 1982;Raftos, 1980). Pool and Seagren (1982) followed six patients receiving 240 mg/day of diltiazem for one year and Hossack et al (1984) evaluated 15 patients taking 360 mg daily for 4 months. Both studies demonstrated continued long-term efficacy of diltiazem with minimal side effects.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of high‐dose verapamil and diltiazem in the long‐term treatment of stable exertional angina

Weiner

McCabe

Cutler

et al. 1984

Clinical Cardiology

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Summary:The efficacy and safety of highdose verapamil (480 mg/day) and diltiazem therapy (360 mg/day) were compared in separate cohorts of 26 and 20 patients, respectively. All patients had stable exertional angina and underwent an initial 6-week double-blind, placebocontrolled, randomized phase followed by a 12-month open-label period. Angina attacks were reduced by veraparml(6.3 f7.5 to 2.5 f4.1 attacks per week, p <0.001) and by diltiazem (9.2f7.5 to 3.0f3.1 attacks per week, p <0.001), while treadmill time increased with both verapamil (372f132 to 444+108 s, p

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Long-term efficacy of diltiazem in chronic stable angina associated with atherosclerosis: Effect on treadmill exercise

Cited by 54 publications

References 8 publications

Efficacy and safety of the 200–300 mg sustained release formulation of diltiazem administered once daily in patients with stable angina

Efficacy and safety of the 200–300 mg sustained release formulation of diltiazem administered once daily in patients with stable angina

The effect of diltiazem and propranolol, alone and in combination, on exercise performance and left ventricular function in patients with stable effort angina: a double-blind, randomized, and placebo-controlled study.

The efficacy and safety of high‐dose verapamil and diltiazem in the long‐term treatment of stable exertional angina

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