A hemodynamic comparison of verapamil, diltiazem, and amlodipine in coronary artery disease

Taylor, Stanley H.; Silke, Bernard; Verma, Shweta; Sharma, Susheel Kumar; Jackson, N.

doi:10.1016/0002-8703(89)90836-3

Cited by 6 publications

(4 citation statements)

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“…According to Taylor et al [13], investigation of hemodynamic parameters at rest and during exercise after intravenous administration of amlodipine in patients with coronary disease revealed that the pulmonary arterial pressure was decreased, cardiac output during exercise was increased, and cardiac pumping efficiency was improved by this drug. Furthermore, the same authors reported that amlodipine has a predominantly peripheral vascular site of action, as compared with diltiazem and verapamil.…”

Section: Discussionmentioning

confidence: 99%

“…However, the antianginal action of amlodipine and the sustained continuation of this action are necessary from the time of administration of the first dose, and if an effective blood concentration of the drug can be attained from the first day of administration, then adequate antianginal efficacy should be obtainable. The acute effect of single intravenous doses of amlodipine with respect to angina has been verified [8,13]; however, the acute effect of orally administered amlodipine has not yet been established. Accordingly, the present study was conducted for the purpose of clarifying the extent of the acute effect and the duration of sustained action of single 10 mg doses of amlodipine, the efficacy and safety of which have already been verified with respect to chronic administration.…”

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confidence: 99%

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Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing?A randomized crossover study in comparison with placebo

Kuroda

Hata

Kunimi

et al. 1992

Cardiovasc Drug Ther

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With eight cases of stable exertional angina as subjects, the antianginal action and sustained effects of single 10 mg oral doses of new calcium antagonists amlodipine were assessed by treadmill exercise tests in randomized crossover trials with respect to a placebo. Exercise tests were conducted before as well as 4, 8, and 24 hours after administration, and plasma amlodipine concentration was investigated at the same times. The maximal exercise time was 299 +/- 43 seconds before as compared with 346 +/- 49 seconds 4 hours after administration and 368 +/- 50 seconds 8 hours after administration, a significant prolongation in each case (p < 0.01). Moreover, the exercise time elapsed until 1 mm of ST-segment depression, as well as the ST-segment depression measured at the same time, were both significantly improved as compared with the placebo results. The plasma amlodipine concentration reached a peak 8 hours after administration and displayed an effective level even 24 hours after administration. The value of delta PRP measured at the same time during the exercise test was also significantly reduced as compared with the placebo results, even 24 hours after administration of amlodipine. These findings supported the conclusion that single 10-mg doses of amlodipine provide stable antianginal action over a 24-hour period.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing?A randomized crossover study in comparison with placebo

Kuroda

Hata

Kunimi

et al. 1992

Cardiovasc Drug Ther

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show abstract

“…37,38 Indeed, in 0 COST-EFFECTIVENESS OF ANTIHYPERTENSIVES Goldberg Arnold et al 183 a multicenter, placebo-controlled trial of patients with symptomatic heart failure (New York Heart Association class 11-III), amlodipine-treated patients experienced improvements in symptoms and functional capacity, as measured by significantly improved exercise time. 33 These findings suggest that the drug leads to neurohormonal regulation that may confer favorable effects on LV function.…”

Section: Amlodipinementioning

confidence: 97%

Cost‐Effectiveness of Antihypertensive Agents in Patients With Reduced Left Ventricular Function

Arnold,

Kaniecki,

Frishman

1994

Pharmacotherapy

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A pharmacoeconomic primer reviews current economic models used to analyze and synthesize information that may be considered in certain health‐related policies or clinical decisions. Heightened budgetary pressures concomitant with mandates for demonstrable increases in efficacy and safety have fostered greater use of cost‐effectiveness analyses (CEAs) throughout the health care industry. In the field of hypertension, major clinical trials of pharmacotherapeutic regimens generally demonstrated benefit of reducing lood pressure; CEAs supplied additional data concerning the optimum selection among alternative antihypertensive therapies. As interest has focused on the preservation of left ventricular (LV) function for the best prognosis, it has become increasingly evident that not all antihypertensive regimens affect LV function in the same way. Thus CEA may be an appropriate method to evaluate these effects and facilitate the identification of a regimen that minimizes deterioration of LV function.

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“…Amlodipine shifted the FrankStarling curve upward and to the left, suggesting improved cardiac pumping efficiency, whereas verapamil depressed the relationship and diltiazem had little effect. 23 In another comparative study, nicardipine, nisoldipine, and verapamil all significantly improved exercise capacity compared with placebo in patients with left ventricular dysfunction and stable angina; however, the three drugs differed in their effects on left ventricular diastolic function. Verapamil improved left ventricular diastolic function to a greater extent than nicardipine, and nisoldipine had no effect.…”

Section: Differences In Efficacy Among Calcium Channel Blockers: Implmentioning

confidence: 98%

Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular dysfunction

Parmley

1992

Clinical Cardiology

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Summary:The use of calcium channel blockers (CCBs) in the treatment of hypertension and concomitant left ventricular dysfunction is reviewed. Some CCBs, particularly second-generation dihydropyridine agents such as felodipine, isradipine, nicardipine, nimodipine, and nitrendipine, have properties that enhance their usefulness in these patients. All CCBs have a similar mechanism of action. Differences in their selective action at various tissue sites determine which are most appropriate for patients with concomitant hypertension and left ventricular dysfunction. Most CCBs do not produce reflex stimulation of the heart or induce intravascular expansion. While all CCBs produce arteriolar dilation, all local beds and regional circulations in target organs are not affected equally. Most CCBs can decrease cardiac mass, and second-generation CCBs tend to have little or no negative inotropic effects at therapeutic dosages. In addition, they increase blood flow and reduce myocardial oxygen requirements. Because of differences in functional and electrophsyiologic effects, specific CCBs may not be appropriate for all patients. Since second-generation dihydropyridine CCBs lack clinically relevant negative inotropic effects, and have been shown to 29, 1991 improve exercise tolerance and coronary artery perfusion, they are appropriate for hypertensive patients with left ventricular dysfunction, angina, and coronary heart disease. Second-generation CCBs tend to lack cardiodepressant side effects and are less likely to react with digoxin than are first-generation CCBs.

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A hemodynamic comparison of verapamil, diltiazem, and amlodipine in coronary artery disease

Cited by 6 publications

References 1 publication

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing?A randomized crossover study in comparison with placebo

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing?A randomized crossover study in comparison with placebo

Cost‐Effectiveness of Antihypertensive Agents in Patients With Reduced Left Ventricular Function

Efficacy and safety of calcium channel blockers in hypertensive patients with concomitant left ventricular dysfunction

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