Effects of felodipine versus nifedipine on exercise tolerance in stable angina pectoris (original) (raw)
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The American Journal of Cardiology, 1984
Exercise tolerance 1, 3 and 8 hours after 80 mg of propranolol, 120 mg of diltiazem and 20 mg of nifedipine, and after 20 minutes of 0.6 mg of sublingual nitroglycerin were compared with placebo in 15 men who had chronic stable angina pectoris. Three hours after drug ingestion, the exercise time was prolonged by 72 f 26,162 f 27 and 161 f 30 seconds (p <0.05) for propranolol, diltiazem and nifedipine, respectively, and by 123 f 35 seconds (p <O.OOl) 20 minutes after sublingual nitroglycerin compared with placebo. The onset of ST-segment depression 20.1 mV was delayed by 120 f 34,203 f 29 and 189 f 35 seconds (p <O.OS) and by 79 f 23 seconds (p <0.05), respectively. Afler propranolol, the peak rate-pressure product decreased compared with placebo (15.1 f 1.1 U [10B3] vs 20.0 f 1.5 U, p <O.Ol). In contrast, the peak rate-pressure product was greater after diltiazem and nifedipine than after placebo (22.2 f 1.3 U [p <O.OSl and 23.8
Circulation, 1983
To investigate the mechanism by which nifedipine improves exercise tolerance in patients with coronary artery disease, we studied 14 patients with stable exertional angina and left anterior descending artery disease by measuring great cardiac vein flow (GCVF) and calculating anterior regional coronary resistance (ARCR) during exercise before and after sublingual administration of 20 mg of nifedipine. After nifedipine seven patients (group I) had no increase in exercise capacity and showed a similar magnitude of ST segment depression at peak exercise, while another seven patients (group II) had prolonged exercise duration (p less than .001) with less ST segment depression at peak exercise (p less than .01). Such effects were achieved despite a significant increase in double product, an indirect index of myocardial oxygen consumption. In group I patients no significant change was induced by nifedipine in GCVF or in ARCR either at rest or at peak exercise. In contrast, in group II pati...
Journal of the American College of Cardiology, 1986
The effects of nifedipine on arterial oxygenation and hemodynamics were studied at rest and during bicycle exercise in 12 men (mean age 55 years, range 41 to 67) with stable exertional angina. The study was conducted double-blind on 2 days, 1 week apart, using a placebocontrolled crossover design. On each day, measurements at rest were made before and 20 minutes after 20 mg sublingual nifedipine or placebo and were followed by measurements made during exercise. Compared with placebo, nifedipine reduced mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance, and increased heart rate and cardiac output at rest and during exercise. It did not alter mean pulmonary artery or pulmonary artery wedgepressures at rest, but decreased them during exercise.
Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy, 1997
This study was designed to compare once-daily administration of 5-10 mg amlodipine with two daily doses of 40 mg sustained-release isosorbide dinitrate in 59 patients with stable angina using a randomized, double-blind, crossover study design. Anginal episodes, nitroglycerin consumption, and possible adverse events were recorded in a diary. A maximal symptom-limited bicycle exercise test and 48-hour ambulatory ECG monitoring were performed at baseline and at the end of each 5-week period of therapy. Exercise time, time to angina, time to ST depression, and maximal ST depression were measured during exercise. During ambulatory monitoring, the number of ischemic episodes and the duration per hour of ST depression were assessed. Amlodipine significantly reduced anginal episodes (P < 0.001) when compared with isosorbide dinitrate. Furthermore, amlodipine prolonged time to ST depression (P < 0.001) and time to angina (P < 0.05) when compared with isosorbide dinitrate. The number...
The American Journal of Cardiology, 1982
To assess the effects of nifedipine on left ventricular function and regional myocardial perfusion, exercise radionuclide ventriculography was performed in 15 men (median age 59 years) and exercise thallium-201 scintigraphy was done in 11 of them, before and 90 minutes after the oral administration of 20 mg of nifedipine. All patients had stable angina and angiographically proved coronary artery disease without evidence of spasm. Exercise tolerance after administration of nifedipine increased from 343 f 42 seconds to 471 150 seconds (p <0 .01), whereas the peak exercise double product remained essentially unchanged (difference not significant). Ejection traction improved significantly at rest (from 49 f 3 .6% to 52 f 3 .3%, p <0 .05) and at peak Nifedipine is a calcium antagonist with potent vasodilating properties.)-1 It has been used successfully in the treatment of stable angina pectoris and other ischemic syndromes 5-10 and has also been noted to have a negative inotropic effect in the isolated cardiac muscle preparation. 11 However, reports on its effects on myocardial function in patients with cardiac disease have been conflicting. 12-14 In particular, its possible influence on the acute left ventricular dysfunction resulting from stress-induced ischemia has not been sufficiently investigated. The present study was designed to assess the effects of nifedipine on left ventricular function at rest and during exercise in patients with coronary artery
International Journal of Cardiology, 1992
The effects of 5 and 10 mg of amlodipine and of placebo were compared in 21 patients with stable angina pectoris and multivessel coronary artery disease. The blind comparison was performed by means of bicycle ergometry and stress echocardiography using esophageal stimulation of the left heart atrium. All patients subsequently received placebo, amlodipine 5 mg and 10 mg for 2 weeks. In bicycle ergometry both doses of amlodipine in comparison with placebo significantly lowered the ST segment depression in lead V5 and prolonged the time to onset of angina. The exercise duration was significantly prolonged only after 10 ,mg of amlodipine. In stress echocardiography 10 mg of amlodipine significantly improved ejection fraction and reduced wall motion score during stimulation and increased peak velocity of relaxation of left ventricular posterior wall at rest and immediately after stimulation. In the patients with left ventricular end-diastolic pressure I 20 mmHg, amlodipine reduced the ratio of peak transmitral flow velocity in atria1 contraction to that in early diastole (A/E) at rest and shortened deceleration time at rest and immediately after stimulation. Amlodipine in patients with stable angina pectoris significantly improved the exercise tolerance and the function of the left ventricle in a dose-dependent way. Amlodipine was well tolerated.
European Heart Journal, 1997
Aims The study aimed to compare the addition of felodipine to metoprolol, and of the replacement of metoprolol by felodipine, with continuation of metoprolol, in patients with angina pectoris despite optimal betablockade. Methods and results The study was double-blind, parallel, randomized and controlled, and comprised 363 patients from 27 outpatient cardiology clinics in the Netherlands. The patients had angina and positive bicycle exercise tests despite optimal beta-blockade (resting heart rate <65 beats. min~ '). Randomization was to three treatment groups: continuation of metoprolol (control), addition of felodipine to metoprolol, and replacement of metoprolol by felodipine. Exercise tests were repeated after 2 and 5 weeks. The main outcome measure was: exercise result after 5 weeks, compared with baseline, betweengroup comparison of changes vs control. There were no significant differences in exercise duration and onset of chest pain vs control. The addition of felodipine increased time until 1 mm ST depression (43 s, 95% confidence interval 20-65 s), and decreased both ST depression at highest comparable work load (0-46 mm, 95% confidence interval 0-19-0-72), and maximal ST depression (0-49 mm, 95% confidence interval 0-23-0-74). Exercise results after replacement of metoprolol by felodipine were not different from control, apart from a significant increase in rate pressure product. Significantly more patients experienced adverse events in the felodipine monotherapy group. Conclusion Combination of metoprolol and felodipine is to be preferred to felodipine monotherapy in patients who have signs and symptoms of myocardial ischaemia despite optimal beta-blockade.