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Efficacy of Nicardipine for Long-Term Therapy of Chronic Stable Angina
Insights
Long-term nicardipine therapy effectively manages chronic stable angina. Patients on nicardipine showed sustained improvement in anginal symptoms and exercise capacity compared to placebo.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina management often relies on short-term clinical trials.
- Limited data exists on the long-term efficacy of antianginal therapies.
Purpose of the Study:
- To assess the long-term effectiveness and safety of nicardipine, a dihydro-pyridine calcium channel blocker, in patients with chronic stable angina.
- To evaluate nicardipine's impact on anginal symptoms and exercise parameters over a 1-year treatment period.
Main Methods:
- Open-label, 1-year treatment with nicardipine in patients with chronic stable angina.
- Dosage titration (20 mg, 30 mg, 40 mg tid) to control anginal symptoms.
- A subsequent 3-week double-blind, placebo-controlled crossover period for a subset of patients.
Main Results:
- Nicardipine effectively controlled anginal symptoms in a majority of patients over 1 year, with only 19% requiring additional nitrates.
- Significant reductions in anginal episodes and improvements in exercise parameters were observed during the open-label phase.
- Patients continuing nicardipine in the double-blind phase demonstrated significantly greater exercise time and time to angina onset compared to placebo.
Conclusions:
- Nicardipine provides effective and sustained symptom control for chronic stable angina over 1 year.
- Long-term nicardipine therapy significantly enhances exercise tolerance and delays angina onset compared to placebo.
- Nicardipine represents a valuable therapeutic option for the long-term management of chronic stable angina.
Abstract:
BACKGROUND: Although angina is a chronic disease, most clinical trials evaluating antianginal therapy are of a few weeks or months in duration. METHODS AND RESULTS: To evaluate the effects of nicardipine, a second-generation dihydro-pyridine calcium channel blocker, as long-term therapy, patients with chronic stable angina were treated for 1 year with open-label nicardipine. Anginal symptoms were controlled with 20 mg tid in 24%, 30 mg tid in 34%, and 40 mg tid in 42%. Of 72 patients completing the 1-year trial, only 14 (19%) had required the addition of long-acting nitrates for control of symptoms. The remaining 57 patients, who had anginal symptoms controlled with nicardipine alone, were continued into the 3-week, double-blind period and were randomized to continue their usual dose of nicardipine or placebo. Throughout the 1-year, open-label treatment period, the number of anginal episodes and exercise parameters of angina were significantly reduced with nicardipine. CONCLUSIONS: During the double-blind period, the patients who continued on nicardipine had significantly greater exercise time and time to onset of angina than patients who were randomized to placebo. The exercise parameters in the patients randomized to placebo were improved over baseline after 1 year of therapy; however, the improvement with nicardipine was significantly greater.