Verapamil versus acebutolol for syndrome X

Romeo, Francesco; Gaspardone, Achilla; Ciavolella, Massimo; Gioffrè, Pier Agostino; Reale, A

doi:10.1016/0002-9149(88)90232-9

Cited by 67 publications

(11 citation statements)

References 6 publications

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“…Recently, -blockers were reported to be efficacious in relieving symptoms and ST-segment depression. 22,[26][27][28] In a study comparing the efficacy of atenolol, amlodipine and nitrate on anginal symptoms in syndrome X, Lanza et al showed that only atenolol significantly reduced the number of anginal episodes. 28 The bradycardic and antiadrenergic effects of -blockade resulted in a reduction of myocardial oxygen demand and an improvement of subendocardial diastolic blood flow.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Suzuki

Matsubara

Koba

et al. 2002

Circ J

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Suzuki

Matsubara

Koba

et al. 2002

Circ J

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“…Coronary microvascular dysfunction, hormonal disturbance, estrogen deficiency, abnormal vasomobility of coronary microvessels, reduced coronary flow reserve, hyperinsulinemia, inappropriate adenosine release, imbalance in the autonomic nervous system and impaired endothelium function are the main factors that have been suggested [2][3][4][5][6][7][8][9]. It is thus not surprising that there is no consensus about treatment, and calcium channel blockers, ß-blockers, aminophylline, angiotensin-converting enzyme (ACE) inhibitors and estrogen replacement have all been used [10][11][12]. In the study described here we evaluated the therapeutic effects of cilazapril, an ACE inhibitor, in patients with syndrome X.…”

mentioning

confidence: 99%

Therapeutic Benefits of Cilazapril in Patients with Syndrome X

et al. 1998

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Objectives: Although the pathophysiology of syndrome X (angina pectoris, positive ECG test findings and normal coronary arteriogram) is unclear, it is generally accepted that intracellular metabolic changes resulting from abnormal constriction of prearteriolar vessels due to endothelium-dependent vasodilation abnormalities may play a role in the pathogenesis. We established the effect of long-term treatment with cilazapril, an angiotensin-converting enzyme inhibitor, which prevents the effect of angiotensin II in the tonic control of vascular resistance. Methods: 18 patients (15 women and 3 men, mean age 43.2 ± 4.6 years) with syndrome X were included in this study. A randomized double-blind crossover placebo-controlled trial was done. After a 1-week washout period, patients received either cilazapril 2 × 2.5 mg or placebo for 3 weeks, followed by 3 weeks of the other therapy. At the end of two periods, an exercise ECG test (modified Bruce protocol) was employed. Results: The magnitude of ST segment depression was significantly decreased during treatment with cilazapril compared with placebo. On the other hand, total exercise time and time to 1 mm ST segment depression were significantly prolonged by cilazapril. However, rate pressure products were not significantly different at peak exercise at or at 1 mm of ST segment depression during both therapies. Conclusion: Cilazapril exerted a beneficial therapeutic effect in cases with syndrome X. The possible mechanism of this effect may be a modulation of coronary tone at the microcirculation level.

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“…Other investigators obtained similar results with propranolol [12,13]. Acebutolol was useful only in a subset of the patients studied [14]. Standard dosage Atenolol: 50 to 100 mg orally once daily.…”

Section: Beta-blocker Therapymentioning

confidence: 60%

“…Furthermore, enrollment criteria and assessment of the effectiveness of therapy varied among studies. Atenolol 100 mg/d + Burgiardini [12] 28 Propranolol 120-160 mg/d + Borghi [13] 24 Propranolol 120-160 mg/d + Romeo [14] 30 Acebutolol 400 mg/d +/-Calcium channel blockers Cannon [15] 17 Verapamil 40-160 mg four times a day + Cannon [15] 9 Nifedipine 10-30 mg four times a day + Borghi [13] 24 Verapamil 320-480 mg/d -Montorsi [16] 18 Nifedipine 10-20 mg four times a day + Burgiardini [12] 28 Verapamil 320 mg/d -Romeo [14] 30 Verapamil 80 mg four times a day + Angiotensin-converting enzyme inhibitors…”

Section: Treatmentmentioning

confidence: 99%

Syndrome X

Suwaidi

Lerman

2000

Curr Treat Options Cardio Med

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Syndrome X, defined as typical angina with positive exercise test results and normal coronary angiographic findings, represents a multifactorial pathophysiologic state that may range from abnormalities in pain perception to abnormalities in endothelial- and nonendothelial-dependent coronary flow reserve associated with myocardial ischemia. Treatment begins with accurate diagnosis by means of a comprehensive coronary vascular reactivity evaluation. This may lay the groundwork for appropriate treatment. The management of patients with syndrome X is challenging, and it may be necessary to attempt various medications depending on the patient's response. We feel that the first step in the treatment is accurate diagnosis. This is done by performing a functional angiogram (assessment of endothelial-dependent and endothelial-independent coronary flow reserve). In those without evidence of coronary flow reserve abnormalities, reassurance might be curative; however, in those who continue to have symptoms, a trial of imipramine therapy at a dose of 50 mg/d may be attempted, provided other organic disorders (in particular gastrointestinal disorders) are excluded. Those who demonstrate evidence of abnormal coronary vascular reactivity are approached as outlined in Figure 1. Patients are advised to avoid medications that may cause coronary "spasm." We routinely refer our patients to the cardiovascular health clinic for risk factor management and an exercise program. Our first choice of medications usually consists of slow-release calcium channel blockers. We tend to start with a once-a-day regimen, and based on the response, we occasionally change the regimen to twice a day. If the functional angiogram reveals concomitant epicardial disease, then nitrates are added to the medical regimen. Angiotensin-converting enzyme inhibitors are part of the treatment if the patient has hypertension or diabetes or if calcium channel blocker therapy fails. l-Arginine at an initial dosage of 1 g three times daily is added and may be increased to 3 g three times daily if no contraindications are present. Because there are no data regarding the effect of l-arginine, which may affect insulin secretion, in patients with diabetes, we use caution in this patient population. There is no "gold standard" therapy for syndrome X, so each patient may respond differently to the initial medical therapy. Thus, we follow these patients closely to monitor their response to treatment.

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Verapamil versus acebutolol for syndrome X

Cited by 67 publications

References 6 publications

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Clinical Characteristics and Follow-up in Patients With Microvascular Angina.

Therapeutic Benefits of Cilazapril in Patients with Syndrome X

Syndrome X

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