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Efficacy of diltiazem for medically refractory stable angina: long-term follow-up
Insights
Long-term diltiazem therapy effectively reduced angina frequency and nitroglycerin use in patients with chronic exertional angina. This treatment, added to beta blockers and nitrates, showed significant benefits over a mean follow-up of 24.6 months.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic exertional angina can be medically refractory, even with standard treatments like beta blockers and nitrates.
- Patients with severe angina may not be suitable for placebo-controlled studies.
Purpose of the Study:
- To evaluate the long-term efficacy of diltiazem as an add-on therapy for chronic exertional angina.
- To assess the impact of diltiazem on angina frequency and nitroglycerin consumption in refractory cases.
Main Methods:
- Prospective study of patients with medically refractory chronic exertional angina.
- Long-term follow-up (mean 24.6 months) with regular patient visits.
- Diltiazem dosage ranged from 120 to 480 mg/day (mean 298 mg/day).
Main Results:
- Angina frequency decreased from 9.5 episodes/week to 3.3 episodes/week at 6 months and maintained this reduction.
- Nitroglycerin consumption also significantly decreased.
- Five patients required coronary bypass surgery due to increased angina; three experienced new cardiovascular events.
Conclusions:
- Long-term diltiazem therapy is effective in reducing angina symptoms and nitroglycerin use in patients with refractory chronic exertional angina.
- While generally well-tolerated, careful monitoring for adverse effects like bradycardia is necessary.
- Diltiazem offers a viable treatment option for patients unresponsive to beta blockers and nitrates.
Abstract:
To assess the efficacy of long-term diltiazem therapy when added to beta blockers and nitrates, we prospectively studied patients with chronic exertional angina who were determined to have medically refractory angina pectoris which was too severe to enter placebo-controlled studies. The mean follow-up time was 24.6 months (8-47 months) and all patients were seen every 2-4 months. Angina frequency decreased from a prediltiazem frequency of 9.5 episodes per week (1-40 per week) to 3.3 attacks per week (0-21 per week) at 6 months and 3.3 attacks per week (0-40 per week) at the patients's last evaluation. Similar reductions in nitroglycerin consumption were reported. Five patients had an increase in angina frequency during the mean 24.6 months of follow-up, which necessitated coronary bypass surgery, 8, 10, 12, 19, and 23 months after study entry, respectively. Diltiazem daily dosage ranged from 120 to 480 mg/day, the mean daily dose was 298 mg/day. Twenty (65%) patients remained on beta-blocker therapy and 19 (61%) patients on nitrate therapy in an effort to achieve a completely pain-free state. New cardiovascular events were documented in 3 patients during the follow-up period, with one patient having an uncomplicated myocardial infarction at 6 months, one patient hospitalized for prolonged chest pain at 2 months, and one patient dying following cardioversion for unrelated atrial fibrillation at 14 months poststudy entry. Adverse effects were reported during 19 of the 354 patient visits, but no patient had to stop therapy because of these. Sinus bradycardia required reduction of beta-blocker dosage in three patients and prolonged PR interval was observed in two additional patients.(ABSTRACT TRUNCATED AT 250 WORDS)