The effect of diltiazem and propranolol, alone and in combination, on exercise performance and left ventricular function in patients with stable effort angina: a double-blind, randomized, and placebo-controlled study.

Hung, Joseph; Lamb, Irene H.; Connolly, Stuart J.; Jutzy, Kenneth; Goris, Michael L.; Schroeder, John S.

doi:10.1161/01.cir.68.3.560

Cited by 152 publications

(26 citation statements)

References 31 publications

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“…The additional use of a 0-blocker blunts this reflex stimulation and may unmask the underlying negative inotropism of the calcium-channel blocker. '0 16 used a similar protocol to evaluate 12 patients. Although the daily dose of propranolol was the same, the dose of diltiazem was twice as high, 360 mg daily.…”

Section: Discussionmentioning

confidence: 99%

Superiority of combined diltiazem and propranolol therapy for angina pectoris.

Strauss¹,

Parisi²

1985

Circulation

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Twenty-four patients with stable angina were evaluated in a 14 week crossover trial. A single-blind placebo period (baseline 1) was followed by two double-blind periods evaluating maximum tolerated doses of diltiazem (up to 360 mg daily) vs placebo. Over the next 1 to 4 weeks, propranolol was started and increased until clinically documented f-blockade was achieved (baseline 2). The final phase consisted of a pair of evaluation periods comparing propranolol plus the maximum tolerated dose of diltiazem to propranolol and placebo. The daily rate of angina attack was 1.6 during baseline, was unchanged during placebo therapy, but fell during treatment with diltiazem to 0.6 (p < .005). With the addition of diltiazem to propranolol, the angina rate was improved (0.3) compared with that with either propranolol alone (0.6) or propranolol and placebo (0.5) (p < .01). Total exercise duration during baseline 1 was 360 sec and increased to 497 sec with diltiazem, 481 sec with propranolol, and 527 sec with the combination of diltiazem and propranolol. Two patients with reduced ejection fractions developed congestive heart failure with propranolol. The combination of diltiazem and propranolol similarly resulted in congestive heart failure in one patient who had tolerated both drugs alone. Circulation 71, No. 5, 951-957, 1985

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Section: Discussionmentioning

confidence: 99%

Superiority of combined diltiazem and propranolol therapy for angina pectoris.

Strauss¹,

Parisi²

1985

Circulation

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“…Hung's work corroborated these ideas and showed that diltiazem in combination with propranolol was more efficacious than propranolol alone or placebo, but was no more efficacious than diltiazem alone for most measured parameters [58]. The combination, however, produced lower left ventricular ejection fractions, comparable to those of propranolol monotherapy.…”

Section: Chronic Stable Anginamentioning

confidence: 86%

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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Calcium-channel antagonists and beta-adrenergic blocking agents have become important modalities in the cardiovascular therapeutic armamentarium. These drugs are often administered as monotherapy to a wide range of cardiological patients with angina pectoris, hypertension, arrhythmias, congestive heart failure, and other diseases. Since within each class these drugs exhibit pharmacologic differences, it follows that their effectiveness varies in different disease states and that they exhibit a wide variety of side effects. In an attempt to optimize therapy, the individual drugs from these two classes can be combined; and the efficaciousness and side-effect profile of various combinations between calcium-channel antagonists and beta blockers are discussed in this review. Recommendations as to which patients may benefit from a combination and as to which patients may be harmed by the combination therapy will be made. Very few studies have compared the safety and efficacy of a single agent with the combination and with placebo in a controlled randomized fashion. To determine which therapy is superior and to determine which combination one should recommend under what circumstances, such placebo-controlled, randomized trials are a necessity, and will hopefully be performed although the complexity is enormous.

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“…The equilibria between the monoprotonated (BH + ) and non-protonated (B) antianginals (acid-base constants, pK a = 7.7-9.45, see Table 1) take place outside the working pH range of a C18 column (3)(4)(5)(6)(7). For these compounds, the retention was thus the same using mobile phases of SDS at pH 3 and 7.…”

Section: Elution Behaviour In Sds-pentanol Mobile Phasesmentioning

confidence: 99%

“…If treatment of angina with calcium channel blockers or ␤-blockers alone in monotherapy fails, an association of both can be effective and safe even in the paediatric age [2][3][4][5][6][7][8][9][10][11]. ␤-Blockers diminish the heart rate, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart, and also decrease myocardial contractility, thus helping to conserve energy or decrease demand.…”

Section: Introductionmentioning

confidence: 99%