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Effect of diuretic therapy on exercise capacity in patients with chronic angina and preserved left ventricular
Helius C Finimundi1, Paulo A Caramori, John D Parker
1Post-Graduate Course in Cardiovascular Disease, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Adding a diuretic to standard treatment significantly improved exercise capacity and reduced angina symptoms in patients with stable angina. This therapy shows potent antianginal effects, particularly beneficial for those with hypertension.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina management often involves multiple antianginal medications.
- Patients with stable angina frequently have comorbidities like hypertension and diabetes.
Purpose of the Study:
- To investigate the antianginal efficacy of diuretic therapy in patients with stable angina already on standard treatment.
- To assess the impact of hydrochlorothiazide plus amiloride on exercise tolerance.
Main Methods:
- A double-blind, placebo-controlled study randomized 40 patients with stable angina and normal left ventricular function.
- Patients received background antianginal therapy and were treated with either a diuretic (hydrochlorothiazide 25 mg plus amiloride 5 mg) or placebo for 21 days.
- Treadmill exercise tests were performed before and after treatment to evaluate changes in walking time and ST-segment depression.
Main Results:
- Diuretic therapy significantly increased treadmill walking time by 63 seconds compared to 19 seconds in the placebo group (P=0.026).
- ST-segment depression was reduced with diuretic treatment (0.6 mm vs 0.1 mm, P=0.03).
- 40% of patients on diuretics showed a significant increase in walking time, versus 5% in the placebo group (P=0.02).
Conclusions:
- Hydrochlorothiazide plus amiloride demonstrates potent antianginal effects in patients with stable angina and preserved left ventricular function on standard therapy.
- The findings suggest a valuable role for diuretics in managing stable angina, especially in hypertensive patients.
- Further research is needed to confirm these effects in non-hypertensive patient populations.
Aim:
This study was designed to determine whether therapy with a diuretic has antianginal effects in patients with stable angina who are already treated with a traditional antianginal regimen.
Methods And Results:
Forty patients with chronic stable angina and normal left ventricular function were randomized in a double-blind, placebo-controlled study. Background antianginal therapy included beta blockers (n = 27), calcium channel antagonists (n = 18), and long-acting nitrates (n = 24). Of the patients 30% had diabetes and 75% had a history of hypertension. Patients were treated with a diuretic (hydrochlorothiazide 25 mg plus amiloride 5 mg) or placebo for 21 days. All patients underwent a treadmill exercise test before randomization and at day 21. The primary end point was the change in treadmill walking time until moderate angina. Diuretic therapy was associated with an increase in treadmill walking time of 63 +/- 17 seconds versus 19 +/- 9 seconds in the placebo group (P = 0.026) and reduced ST-segment depression (0.6 +/- 0.2 mm versus 0.1 +/- 0.2 mm (P = 0.03). There was a 25% increase in walking time in 8 patients (40%) treated with diuretic versus 1 patient (5%) in the placebo group (P = 0.02). The increases did not depend on changes in blood pressure or heart rate.
Conclusion:
Therapy with hydrochlorothiazide plus amiloride has potent antianginal effects in patients with stable angina and preserved left ventricular function under treatment with standard antianginal therapy. Because most of the study patients had a history of hypertension the extrapolation of these findings to patients who did not have hypertension requires further investigation.
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