Combination of Calcium Channel Blockers and Beta Blockers for Patients with Exercise-Induced Angina Pectoris: A Double-Blind Parallel-Group Comparison of Different Classes of Calcium Channel Blockers

Combination of Calcium Channel Blockers and Beta Blockers for Patients with Exercise-Induced Angina Pectoris: A Double-Blind Parallel-Group Comparison of Different Classes of Calcium Channel Blockers

The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative...

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Bibliographic Details
Published in:Angiology Vol. 50; no. 6; pp. 447 - 454
Main Authors: van der Vring, J.A.F.M., Daniëls, M.C.G., Holwerda, N.J.H., Withagen, P.J.A.M., Schelling, A., Cleophas, T.J., Hendriks, M.G.C.
Format: Journal Article
Language:English
Published: Thousand Oaks, CA SAGE Publications 01-06-1999
Westminster
Subjects:
Antianginal agents. Coronary vasodilator agents
Biological and medical sciences
Cardiovascular system
Medical sciences
Pharmacology. Drug treatments
Antianginal agent
Human
Drug combination
Mibefradil
Calcium antagonist
Benzothiazepine derivatives
Cardiovascular disease
Angina pectoris
Diltiazem
Coronary heart disease
Chemotherapy
Treatment
Amlodipine
Double blind study
Exercise tolerance test
Dihydropyridine derivatives
Hemodynamics
Comparative study
Beta blocking agent
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Summary:The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depres sion on ETT (p<0.001 for any treatment versus baseline). In addition, mibefradil, both low- and high-dose treatment, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, p<0.003 and <0.001, respectively; high (continued on next page) dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, p<0.001 and <0.001, respectively). These effects were linearly correlated to the amount of rate pressure product (RPP) reduction. Serious symptoms of dizziness likewise occurred significantly more frequently with mibefradil (p<0.05) and led 19 patients taking mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with negative chronotropic property provide better delay of ischemia in patients with exercise-induced angina but that the concomitant risk of intolerable dizziness largely reduces this benefit.
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ISSN:0003-3197
1940-1574
DOI:10.1177/000331979905000602