Felodipine in chronic stable angina: a randomized, double-blind, placebo-controlled, crossover study

Abstract

To investigate the antianginal efficacy and tolerability of felodipine, a new dihydropyridine calcium antagonist, 20 patients with stable exertional angina, not completely controlled by beta-blocker monotherapy, entered a randomized, double-blind, placebo-controlled, crossover study. Patients on standard beta-blocker therapy, who had at least 3 weekly anginal episodes and a reproducible exercise test (stopped for angina and ECG signs of ischaemia) at the end of 2 weeks placebo treatment, were eligible for the study. They were randomized to one sequence of treatment: felodipine 5 mg twice daily for 2 weeks followed by placebo for a further 2 weeks, or vice versa. Beta-blocker treatment was unchanged throughout the study. A treadmill test was carried out at the end of each crossover period, 2-4 h after drug administration. The number of anginal attacks and nitroglycerin consumption was recorded on a diary card. At rest, felodipine significantly (P less than 0.05) reduced standing systolic but not diastolic blood pressure. Heart rate was not modified by the active treatment. At ischaemic threshold and at peak exercise, heart rate, systolic blood pressure and rate-pressure product remained unchanged. Exercise duration was increased by felodipine (P less than 0.01) and maximal ST change was reduced (P less than 0.01). Time to 1 mm ST depression was prolonged non-significantly by felodipine (basal 5.7 +/- 1.5, felodipine 7.4 +/- 2.0, placebo 6.6 +/- 1.5 min). The number of patients who stopped exercise due to angina and ST change was 20/20 at baseline, 16/20 with placebo and 10/20 with felodipine. Felodipine significantly reduced weekly anginal episodes (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Relative efficacy of antianginal drugs used as add-on therapy in patients with stable angina: A systematic review and meta-analysis

“…There were 28 studies (37 comparisons) of a CCB added to a BB ( n = 2468); 7–35 12 studies (12 comparisons) of a BB added to a CCB ( n = 1489); 9,11,12,14–16,19,20,24,25,29,34 7 studies (8 comparisons) of a LAN added to a BB or CCB ( n = 329); 7,36–40 3 studies (4 comparisons) of ranolazine added to a BB or CCB ( n = 1388); 41–43 8 studies (9 comparisons) of trimetazidine added to a BB or CCB ( n = 2875); 44–51 1 study of ivabradine added to a BB ( n = 889). 52 No studies were found that evaluated the impact of nicorandil in an add-in role on either ETT or clinical measures of anti-anginal efficacy.…”

Tolerability and Safety of Felodipine

“…The coronary blood flow increased as a consequence of dilation of both coronary resistance vessels and epicardial coronary arteries (33). A preliminary clinical program in patients with exertional angina showed that felodipine exerts antianginal effects both in monotherapy and in combination with a P-blocker (14, 75,97,99,110). The duration of these studies ranged from 1 day to 4 weeks and exercise tolerance increased by 10-60% and the anginal attack rate and consumption of nitroglycerin were reduced.…”

Bisoprolol Alone and in Combination With Amlodipine or Nifedipine in the Treatment of Chronic Stable Angina

“…The number of patients with chest pain during exercise was significantly reduced and, in those patients who had early onset chest pain (<6 min) at baseline exercise testing, there was a significant increase in the time to chest pain in the amlodipine group. There are numerous other smaller randomised trials which have also shown no advantage in combining dihydropyridines and beta‐blockers 20‐22 …”