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[Comparative study of effects of diltiazem, nifedipine and their combination on exercise stable angina]
1Service de cardiologie A, CHU Timone, Marseille.
Insights
Diltiazem monotherapy improved stable angina more effectively than Nifedipine. Combining Diltiazem and Nifedipine did not offer additional benefits and increased side effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina pectoris is a common cardiovascular condition.
- Calcium channel blockers like Diltiazem and Nifedipine are used for angina management.
- The potential synergistic effects of combining Diltiazem and Nifedipine warrant investigation.
Purpose of the Study:
- To evaluate the clinical benefits of combining Diltiazem and Nifedipine in patients with stable angina.
- To compare the efficacy and safety of Diltiazem, Nifedipine, and their combination against placebo.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Eighteen patients with stable angina underwent four treatment periods: placebo, Diltiazem, Nifedipine, and Diltiazem with Nifedipine.
- Clinical evaluation included exercise stress testing and drug plasma concentration monitoring.
Main Results:
- Both Diltiazem and Nifedipine treatments showed significant improvement compared to placebo.
- Diltiazem demonstrated superior efficacy over Nifedipine in preventing angina during exercise and increasing exercise tolerance (p < 0.05).
- The combination therapy did not yield better results than Diltiazem alone and was associated with more adverse events.
Conclusions:
- Diltiazem monotherapy is more effective than Nifedipine for stable angina.
- Combining Diltiazem and Nifedipine offers no additional therapeutic advantage and increases the risk of side effects.
- Further research may explore optimal dosing or alternative combinations for refractory angina.
Abstract:
Diltiazem and Nifedipine could be synergic. The aim of this study was to investigate the benefits of their association. Eighteen patients, 15 men and 3 women, average age 61 +/- 6 years, with stable angina on effort, were studied. Eight patients had single vessel disease and 10 patients had multivessel disease. The patients underwent a randomised double-blind trial with 4 successive treatment periods each lasting one week: placebo; 360 mg/day of Diltiazem; 60 mg/day of Nifedipine; 180 mg/day of Diltiazem with 30 mg/day of Nifedipine. The benefits were evaluated clinically, by exercise stress testing and with drug plasma concentrations at the end of each sequence. The results at the end of the 3 treatment periods were significantly better than with placebo. Diltiazem was significantly better than Nifedipine with respect to the development of angina during exercise testing (1 patient compared with 7 patients) and to maximum load (118.3 +/- 33.3 watts compared with 105.9 +/- 35.4 watts) (p less than 0.05). The association of the two drugs did not give better results than Diltiazem alone. Compared with placebo, the total duration of exercise testing and the duration of 1 mm ST depression were significantly longer during the 3 treatment sequences but there were no significant differences between each of them. Secondary effects were significantly more common with Nifedipine (7 patients) and with the drug association (9 patients) than with Diltiazem alone (3 patients) or placebo (1 patient). Plasma concentrations of Diltiazem were 328 +/- 35 ng/l with the 360 mg/day dosage and 137 +/- 52 ng/l with the 180 mg/day dosage.(ABSTRACT TRUNCATED AT 250 WORDS)