Randomized double-blind comparison of verapamil and nifedipine in chronic stable angina

Subramanian, Vijay; Bowles, Michael J.; Khurmi, Nardev S.; Davies, Anthony B.; Raftery, Edward B.

doi:10.1016/0002-9149(82)91221-8

Cited by 66 publications

(7 citation statements)

References 28 publications

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“…reflex mediated tachycardia in conscious animals, as demonstrated in the present study. The group II calcium antagonists, on the other hand, have been shown to have well balanced effects in heart and smooth muscle, resulting in a fall in blood pressure accompanied by direct effects on the heart (Spedding, 1982;Subramanian et al, 1982;Hof, 1984), particularly causing sinus slowing or atrioventricular block, although these effects are usually readily offset by reflex adaptations. In the present study, the small fall in MAP induced by transdiclofurime (0.3pmolkg-') was accompanied by a decrease in HR, which may be due to direct effects on the heart in the absence of reflex, compensatory tachycardia.…”

Section: Discussionmentioning

confidence: 99%

“…The group II calcium antagonists are particularly beneficial in cardiovascular disease, due to their wellbalanced inhibitory effects in heart and smooth muscle, and therefore have been shown to be superior antiarrhythmic and antianginal agents as compared to the dihydropyridines which have a propensity to cause marked reflex tachycardia (Subramanian et al, 1982). However, despite the proven effectiveness of this group of calcium antagonists in the clinic there remain very few examples of potent group II calcium antagonists.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the cardiovascular effects of trans‐diclofurime with different types of calcium antagonists in conscious spontaneously hypertensive rats

Petty¹,

Mir²

1988

British J Pharmacology

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1 Trans-diclofurime has been shown to be a potent group II calcium antagonist in in vitro and in vivo test systems. In contrast to the dihydropyridines, group II calcium antagonists have a reduced propensity to cause reflex tachycardia due to well-balanced inhibitory effects in smooth muscle and heart. Since effects on autonomic reflexes are more reliably assessed in conscious animals, the cardiovascular effects of trans-diclofurime have been examined and compared to those of nifedipine, verapamil and diltiazem in the conscious spontaneously hypertensive rat (SHR). 2 Each SHR had an indwelling catheter in the femoral artery to record mean arterial pressure (MAP) and heart rate (HR) and a cannula in the femoral vein for drug infusion over 1 min.3 Nifedipine (0.1-3.0.umolkg-1 i.v.) caused dose-related falls in MAP accompanied by doserelated increases in HR. Trans-diclofurime and verapamil (0.3-3.0pmol kg-i.v.) also caused doserelated decreases in MAP, but significant tachycardia was only seen at 1.0 and 3.0pmolkg-'.Trans-diclofurime (0.31pmolkg-1) induced a significant fall in HR. Diltiazem (1.0-10.0pmolkg-' i.v.) induced dose-related falls in MAP, significant bradycardia was evident with 1.0 pmol kg-' and tachycardia with lOumolkg-1. Trans-diclofurime and diltiazem induced less tachycardia than nifedipine and verapamil for equivalent falls in MAP. 4 These results suggest that trans-diclofurime is a potent antihypertensive agent in conscious SHR and, like diltiazem, the hypotensive effects are associated with less tachycardia than is usually apparent with calcium antagonists such as nifedipine or verapamil. SThe cardiovascular effects of trans-diclofurime in conscious SHR are those expected of a class II calcium antagonist and are consistent with its proposed mode of interaction with the diltiazem site in the calcium channel.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the cardiovascular effects of trans‐diclofurime with different types of calcium antagonists in conscious spontaneously hypertensive rats

Petty¹,

Mir²

1988

British J Pharmacology

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“…Ambulatory ST-segment monitoring and multistage graded exercise testing (Khurmi et ul. , 1984a-c;Subramanian et al, 1982), were performed to assess the effects of propranolol on ST-segment changes and other objective indices of intermittent myocardial ischemia. This study was aimed to clearly delineate the precise influence of propranolol on heart rate, exercise tolerance, and ischemic ST-segment changes.…”

Section: Discussionmentioning

confidence: 99%

Effect of propranolol on indices of intermittent myocardial ischemia, assessed by exercise testing and ambulatory st‐segment monitoring

Khurmi¹,

Bowles²,

O'Hara³

et al. 1986

Clinical Cardiology

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Summary: Seventy three patients (63 males and 10 females) aged 41-75 years with established stable exertional angina pectoris were studied in a double-blind fashion to confirm the efficacy of 80 mg propranolol administered three times daily and also to examine its effect on STsegment changes in the electrocardiogram by ambulatory ST-segment monitoring and exkrcise testing using on-line computer analysis. During ambulatory monitoring, episodes of ST-segment depression in lead CMS were significantly reduced from 6.5f0.7 during placebo to 3.4f0.6 during pmpranolol therapy (p

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“…In patients with baseline low exercise tolerance improvement in time to 1 mm ST depression was better in metoprolol group (68 sec Vs 42 sec p<0.05) [47]. Non-dihydropyridines are more effective than dihydropyridines with fewer adverse effects [48–50]. Studies have shown that verapamil and diltiazem are as effective in preventing angina and improving exercise tolerance as BBs [51–54].…”

Section: Management Of Anginamentioning

confidence: 99%

Advancements in pharmacotherapy for angina

Jain

Elgendy

Al‐Ani

et al. 2017

Expert Opinion on Pharmacotherapy

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Introduction Angina pectoris is the most prevalent symptomatic manifestation of ischemic heart disease, frequently leads to a poor quality of life, and is a major cause of medical resource consumption. Since the early descriptions of nitrite and nitrate in the 19th century, there has been considerable advancement in the pharmacologic management of angina. Areas covered Management of chronic angina is often challenging for clinicians. Despite introduction of several pharmacological agents in last few decades, a significant proportion of patients continue to experience symptoms (i.e., refractory angina) with subsequent disability. For the purpose of this review, we searched PubMed and Cochrane databases from inception to August 2016 for the most clinically relevant publications that guide current practice in angina therapy and its development. In this article, we briefly review the pathophysiology of angina and mechanism-based classification of current therapy. This is followed by evidence-based insight into the traditional and novel pharmacotherapeutic agents, highlighting their clinical usefulness. Expert opinion Considering the wide array of available therapies with different mechanism efficacy and limiting factors, a personalized approach is essential, particularly for patients with refractory angina. Ongoing research with novel pharmacologic modalities is likely to provide new options for management of angina.

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Randomized double-blind comparison of verapamil and nifedipine in chronic stable angina

Cited by 66 publications

References 28 publications

Comparison of the cardiovascular effects of trans‐diclofurime with different types of calcium antagonists in conscious spontaneously hypertensive rats

Comparison of the cardiovascular effects of trans‐diclofurime with different types of calcium antagonists in conscious spontaneously hypertensive rats

Effect of propranolol on indices of intermittent myocardial ischemia, assessed by exercise testing and ambulatory st‐segment monitoring

Advancements in pharmacotherapy for angina

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