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[Combination therapy with slow release isosorbide nitrate and diltiazem in silent myocardial ischemia]
B Brisse1, T Behrenbeck, U Ebert
1Medizinische Klinik und Poliklinik, Münster.
Insights
This study found that a combination of isosorbide dinitrate/isosorbide mononitrate (ISDN/ISMN) and diltiazem significantly reduced silent myocardial ischemia in patients with coronary heart disease (CHD). The combination therapy achieved over 80% reduction in ischemic events.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary heart disease (CHD) poses a significant health burden.
- Silent myocardial ischemia is a common manifestation of CHD.
- Effective management strategies for silent myocardial ischemia are crucial.
Purpose of the Study:
- To evaluate the efficacy of a once-daily oral medication combining isosorbide dinitrate/isosorbide mononitrate (ISDN/ISMN) and diltiazem (D) in patients with CHD.
- To assess the impact of this combination therapy on silent myocardial ischemia.
Main Methods:
- A placebo-controlled study involving 11 patients with angiographically proven CHD.
- Patients received ISDN/ISMN and diltiazem in long-acting preparations.
- Long-term 24-hour ECG monitoring was conducted under placebo and during treatment periods.
Main Results:
- Once-daily ISDN/ISMN significantly reduced silent myocardial ischemia.
- Combination therapy with ISDN/ISMN and diltiazem led to a greater than 80% reduction in the frequency and duration of ischemic events in 72% of patients.
- Maximal heart rate increase during ST-depression decreased significantly with combination therapy.
Conclusions:
- Once-daily long-acting ISDN/ISMN is effective in reducing silent myocardial ischemia.
- Combination therapy with ISDN/ISMN and diltiazem offers improved efficacy, significantly reducing ischemic events.
- This combination therapy represents a promising treatment option for managing silent myocardial ischemia in CHD patients.
Abstract:
In 11 patients (2 female, 9 male) suffering from angiographically proven CHD (age 45-60 years; 54.3 years on an average) the efficacy of a once-daily oral medication with 120 mg ISDN/50 mg ISMN and diltiazem (D) each in a long-acting preparation was examined in a placebo-controlled study. Each period lasted for 3 days; 2 capsules were given at 0700 a.m. one capsule at 5 p.m. Long-term ECG-recordings for 24 hrs (Tracker recorder, Pathfinder III) were performed twice under placebo and once during the third day of ISDN or ISMN, ISDN/ISMN + D in the morning and JSDN or ISMN in the morning and D in the afternoon. The rate of ischemic events declined from 10.4 to 4.7, 3.3 and 2.2; the duration of ischemia in 24 hours declined from 128 min to 43 min, 44 min and 34 min. The product of ST-depression (mV) and time of duration (min) showed an equivalent course. A more than 80% reduction of ischemia (duration and frequency) was achieved by a combination therapy in 72% of the patients. Minimal increase of heart rate at the beginning of ST-depression increased significantly during all periods of therapy, maximal increase of heart rate at that time showed a decrease only during combination therapy with D, the mean value did not change significantly. The once-daily application of ISDN/ISMN (50 mg) in a long-acting preparation (120 mg) led to a significant reduction of silent myocardial ischemia. The efficacy of ISDN/ISMN can be improved by D (120 mg, long acting preparation) up to a greater than 80% reduction in frequency and duration of ischemic events.