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A randomised double-blind crossover study of isosorbide mononitrate and nifedipine retard in chronic stable angina
F Akhras1, J Chambers, S Jefferies
1Department of Cardiology, Guy's Hospital, London, U.K.
Insights
Nifedipine retard and isosorbide-5-mononitrate effectively treat stable angina pectoris, offering similar clinical improvements. Combination therapy may provide further benefits, as neither drug showed tolerance after two weeks.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina pectoris is a common condition resulting from coronary arterial disease.
- Effective monotherapy is crucial for managing symptoms and improving patient quality of life.
Purpose of the Study:
- To compare the efficacy and safety of nifedipine retard and isosorbide-5-mononitrate as monotherapy for stable angina.
- To evaluate their impact on exercise tolerance and anginal symptoms.
Main Methods:
- A randomized, placebo-controlled, double-blind crossover study involving 18 patients with coronary arterial disease.
- Comparison of isosorbide 20 mg twice daily, sustained-release isosorbide 40 mg once daily, and nifedipine 20 mg twice daily over two-week periods.
- Subjective (anginal attacks, glyceryl trinitrate use) and objective (treadmill stress tests) assessments.
Main Results:
- All active treatments significantly improved exercise parameters (time to ST depression, duration) and reduced anginal symptoms compared to placebo.
- No significant differences were observed between nifedipine retard and isosorbide-5-mononitrate in efficacy or safety.
- Neither drug demonstrated tolerance after two weeks of therapy.
Conclusions:
- Nifedipine retard and isosorbide-5-mononitrate are equally effective as initial monotherapy for stable angina.
- Combination therapy might offer enhanced benefits due to residual symptoms and ischemia.
- Both agents are safe and well-tolerated for short-term use in stable angina patients.
Abstract:
In order to evaluate and compare the efficacy and safety of nifedipine retard and isosorbide-5-mononitrate as monotherapy in the treatment of stable angina, 18 patients with abnormal exercise electrocardiograms and angiographically proven coronary arterial disease were studied in a randomised placebo controlled double-blind crossover study comparing isosorbide 20 mg twice a day, sustained released isosorbide 40 mg once daily and nifedipine 20 mg twice a day each given for two weeks. Patients were assessed subjectively by counting the frequency of anginal attacks and glyceryl trinitrate consumed and objectively by maximal symptom-limited treadmill stress tests performed at "trough" therapeutic blood levels on the last day of each treatment period. There were no significant differences in all parameters between entry and run-out placebo. Compared to placebo, all three active treatments showed significant improvement in exercise time to 1 mm ST segment depression, amount of maximum ST segment depression and exercise duration. All three active treatments also significantly reduced the consumption of glyceryl trinitrate and frequency of anginal attacks. There were no significant differences between active treatments. Thus similar clinical improvements were produced by nifedipine retard and isosorbide, both being shown to be equally effective starting therapy for the treatment of patients with stable angina pectoris. Although anginal frequency was reduced by one third and exercise time increased residual symptoms and exercise ischaemia suggest that nifedipine retard and isosorbide may be more clinically useful in combination therapy. Neither demonstrated tolerance after two weeks of therapy.