Improved exercise tolerance after propranolol, diltiazem or nifedipine in angina pectoris: Comparison at 1, 3 and 8 hours and correlation with plasma drug concentration

Chaitman, Bernard R.; Wagniart, P; Pasternac, A; Brevers, Genevieve; Scholl, Jean-Marie; Lam, Jules Y.T.; Methe, RN Margot; Ferguson, R. James; Bourassa, Martial G.

doi:10.1016/0002-9149(84)90674-x

Cited by 81 publications

(17 citation statements)

References 33 publications

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“…This finding has also been observed by Chaitman et al [6] for propranolol, and probably means that the myocardial oxygen supply is decreased since patients have exhibited higher anginal threshold, namely higher heart rate and systolic rate-pressure product at on set of ischemia during control exercise. How ever.…”

Section: Discussionsupporting

confidence: 83%

“…However, despite a similar attenuation of exercise tachycardia which suggests the equipotency of the 2 betablocker doses [3], the changes in exercise du ration were not significant in the propranolol group. It is likely that the dose of propranolol was nevertheless too small: a larger dosage was used in other studies [9][10][11], As pointed out by Chaitman et al [6], the magnitude of the changes in exercise capacity can be corre lated with the plasma propranolol level.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Immediate Effects of Two Beta-Blocking Drugs: A Nonselective and a Cardioselective with Modest ISA in Exercise-Induced Angina

et al. 1987

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To compare the effects of two beta-blocking drugs: a nonselective (propranolol) and a cardioselective with modest intrinsic sympathomimetic activity (visacor), 24 patients with stable angina pectoris performed a control exercise (without medication) on a bicycle ergometer (increments of 30 W every 3 min), and thereafter were randomized to receive either propranolol (40 mg t.i.d.) or visacor (200 mg once daily) for a 48-hour double-blind trial. The 2 groups on control exercise were similar with regard to their exercise tolerance: 7.6 ± 2.3 versus 7.1 ± 1.4 min (NS) and the behavior of heart rate, systolic, diastolic blood pressure and double product, at rest and during exercise. They exercised on the 2nd day 2 h after the intake of propranolol or visacor. In the 12 patients randomized to propranolol, heart rate, systolic and diastolic pressures, double product were significantly reduced at rest, compared with control exercise: 67 ± 8 versus 81 ± 10 beats/min (p < 0.01), 132 ± 20 versus 146 ± 21 mm Hg (p < 0.02), 80 ± 8 versus 88 ± 10 mm Hg (p < 0.02), 8,828 ± 1,927 versus 11,863 ± 2,138 mm Hg·min-¹ (p < 0.001), respectively. On the contrary, in the 12 patients randomized to visacor, these parameters at rest were less modified and only heart rate was significantly decreased: 71 ± 9 versus 81 ± 11 beats/min (p < 0.05). The onset of ST-segment depression (≧ 1.0 mm) was delayed 14% (p < 0.05) in the propranolol group, and 31 % (p < 0.01) in the visacor group. The peak double product decreased 27% (p < 0.001) in the propranolol group and 17% (p < 0.02) in the visacor group. Both drugs increased exercise duration, but only in the visacor group, the changes were significant (17%, p < 0.02, vs. 5%, NS in propranolol group). In conclusion, visacor seems to be at least as efficient as propranolol in exercise-induced angina.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Comparison of the Immediate Effects of Two Beta-Blocking Drugs: A Nonselective and a Cardioselective with Modest ISA in Exercise-Induced Angina

et al. 1987

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“…ml. The relationship between the plasma concentration of nifedipine and the clinical effect in this study supports the data from dose-response studies carried out with nifedipine monotherapy by other workers [39][40][41]. However, it obscures the wide interindividual variability in the response to a given plasma concentration of the drug.…”

Section: Duration Of Action Of Beta-adrenoceptor Antagonist--nifedipisupporting

confidence: 89%

Beta-adrenoceptor antagonists plus nifedipine in the treatment of chronic stable angina pectoris

Challenor

Waller

George

1989

Cardiovasc Drug Ther

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The antianginal effects of beta-adrenoceptor antagonists are achieved by a reduction in myocardial oxygen demand. This is a rational approach to treatment in patients whose angina is caused by a fixed stenosis. However, dynamic coronary vasospasm is an important factor in patients with chronic stable angina. Nifedipine increases myocardial oxygen supply by reducing coronary vascular tone and is a logical approach to treatment in these patients. For monotherapy of angina, nifedipine is less effective than the beta-adrenoceptor antagonists, but the combination has additive effects in reducing the frequency of anginal episodes and improving exercise tolerance. Plasma concentrations of nifedipine are closely related to clinical efficacy, and the variable first-pass metabolism of the drug leads to wide interindividual differences in peak concentrations and duration of action. Increasing the size of individual doses of nifedipine carries a risk of enhanced side effects due to high peak plasma concentrations. Optimal treatment may be more appropriately achieved in some patients by a slow release formulation, but with an increased frequency of administration.

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“…Such studies have confirmed the equivalent effectiveness of diltiazem (Chaitman et al, 1984;Yamak- Tilmant et al, 1983) and this has been shown also against the cardiospecific drug metoprolol in hypertension (Trimarco et al, 1984). Verapamil and nifedipine are the two calcium antagonists most firmly established in clinical practice.…”

Section: Discussionmentioning

confidence: 69%

“…In the case of diltiazem, many of these studies have been undertaken in the USA and are concerned with its two main actions in hypertension and angina, respectively. Studies in hypertension have shown the drug to be effective with a duration ofaction of 8-12 h (Olivari et al, 1979); and in angina to have a maximal effect 3-8 h after dosage (Chaitman et al, 1984). Open and controlled studies have both confirmed the effectiveness of diltiazem (Hossack et al, 1982a,b;Strauss et al, 1982;Feldman et al, 1982).…”

Section: Discussionmentioning

confidence: 99%

A comparison of diltiazem and atenolol in angina

Wheatley¹

1985

Postgraduate Medical Journal

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Summary:Diltiazem was compared to atenolol in a double-blind trial involving 78 patients suffering from coronary heart disease. Following a 2 week control period, patients were randomly allocated to 6 weeks treatment with one or the other drug.The patients themselves made daily records of anginal attacks, trinitrate requirements, well-being and exercise tolerance. With both drugs there were highly significant reductions in the anginal attack rate and trinitrate requirements, and significant improvement on the other measures. However, there were no significant between drug differences.The incidence of side effects with diltiazem was very low and no patient had to omit treatment for this reason, although three patients did so on atenolol.

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Improved exercise tolerance after propranolol, diltiazem or nifedipine in angina pectoris: Comparison at 1, 3 and 8 hours and correlation with plasma drug concentration

Cited by 81 publications

References 33 publications

Comparison of the Immediate Effects of Two Beta-Blocking Drugs: A Nonselective and a Cardioselective with Modest ISA in Exercise-Induced Angina

Comparison of the Immediate Effects of Two Beta-Blocking Drugs: A Nonselective and a Cardioselective with Modest ISA in Exercise-Induced Angina

Beta-adrenoceptor antagonists plus nifedipine in the treatment of chronic stable angina pectoris

A comparison of diltiazem and atenolol in angina

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