Therapy of Angina Pectoris with Propranolol and Long-Acting Nitrates

Abstract

A double-blind study of the effects of isosorbide dinitrate, 10 mg given orally four times a day, propranolol, 40 mg four times a day, and the combination of these two drugs was performed on 21 patients with angina pectoris. Each patient received placebo, isosorbide, propranolol, and the combination of the two drugs for 1 month each in a random sequence over 4 months. The number of anginal pains and nitroglycerin tablets used were recorded, and a multistage treadmill ECG exercise test was performed after each treatment period. Frequency of anginal pains was reduced significantly with propranolol (7.0±2.5 pains/week) and the combination of propranolol and isosorbide dinitrate (9.9±2.9) as compared with placebo (21.0±6.4). Similarly, the number of nitroglycerin tablets was reduced with propranolol-containing regimens. Isosorbide was not significantly better than the placebo. Symptomatic improvement with propranolol could be related to a reduction in heart rate, and the product of heart rate and systolic blood pressure during exercise ( P <0.001). The capacity of these patients to perform a multistage exercise test, however, was not improved significantly, and the ischemic ST-segment changes were not altered by the treatments. Thus, propranolol appeared to be effective on the symptoms of angina pectoris, but it did not significantly improve exercise performance, and it did not prevent the ischemic patterns in the exercise ECG in this group of patients. Isosorbide dinitrate, alone or in combination with propranolol, was ineffective in this study.

A controlled comparison of oxyfedrine, isosorbide dinitrate and placebo in the treatment of patients suffering attacks of angina pectoris.

“…Such findings are in agreement with the feelings of many clinicians that nitrates only have a therapeutic role for alleviation of acute symptoms (Goldberg et al, 1969). There is also a recognized high incidence of unpleasant headaches in patients treated with isosorbide dinitrate.…”

Nitrate: Warum und wie sie heute eingesetzt werden sollten

“…Der v611ige Verlust antiischfimischer Wirkungen 4 Std nach Einnahme von 15-120 mg Isosorbid-Dinitrat in unretardierter Form alle 6 Std wurde 1982 berichtet [122]. [118,126,127,130]. [118,126,127,130].…”

Synergistic Actions of Nitrite-β-Adrenergic Blocking Agents in the Therapy of Angina Pectoris

“…The synergism of nitrites and /3-blockers is not yet a settled issue [4,5,10,24,51]. Encouraging reports have appeared [1, 2, 41, 43, 44, 59-61, 62a, 67], and several reviews have mentioned it as a logical ap proach [12,14,39,46,65], Other reports have been less encouraging [4,5,10,24], Most studies have involved the use of sublingual nitroglycerin or iso- Arrows reflect the approximate magnitude and direction of the response.…”

“…Encouraging reports have appeared [1, 2, 41, 43, 44, 59-61, 62a, 67], and several reviews have mentioned it as a logical ap proach [12,14,39,46,65], Other reports have been less encouraging [4,5,10,24], Most studies have involved the use of sublingual nitroglycerin or iso- Arrows reflect the approximate magnitude and direction of the response. •f-Small increase, 4' small decrease, moderate increase, 4" 4' moderate decrease, ▲ large increase, T large decrease.…”