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Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial
Insights
Nicardipine, a calcium channel blocker, improved exercise capacity and delayed angina in patients with chronic stable angina. While generally well-tolerated, some cardiovascular side effects were noted.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Dihydropyridine calcium channel blockers are used for cardiovascular conditions.
- Nicardipine is a novel agent in this class.
Purpose of the Study:
- To evaluate the efficacy and safety of nicardipine in patients with chronic stable angina.
- To assess nicardipine's effects on exercise parameters and anginal symptoms.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled, crossover trial.
- 63 patients received nicardipine (30 or 40 mg TID) or placebo.
- Evaluated resting and exercise hemodynamics, exercise duration, and angina frequency.
Main Results:
- Nicardipine mildly increased resting heart rate and decreased resting blood pressure.
- Peak exercise heart rate increased 7% and peak exercise blood pressure decreased 6%.
- Significant improvements were observed in exercise duration (9%), time to angina (15%), time to ST depression (16%), and peak oxygen consumption (13%).
Conclusions:
- Nicardipine is effective in improving exercise tolerance and reducing angina symptoms in chronic stable angina.
- The drug was generally well-tolerated, with mild vasodilatory side effects reported.
- Further investigation into cardiovascular side effects, including potential angina exacerbation, is warranted.
Abstract:
Nicardipine, a new calcium channel blocking drug of the dihydropyridine family, was administered to 63 patients at a dose of 30 or 40 mg 3 times daily in a multicenter, randomized, double-blind, placebo-controlled, crossover trial. Nicardipine midly increased heart rate (HR) at rest and midly decreased the blood pressure (BP) at rest. When generally similar responses to the 30- and 40-mg doses were averaged, nicardipine produced a 7% increase in peak exercise HR, which was balanced by a 6% decrease in peak exercise BP. Thus, no change occurred in the exercise HR-BP product. With nicardipine, treadmill exercise duration increased 9%, time to angina increased 15%, time to 1-mm ST-segment depression increased 16%, and oxygen consumption at peak exercise increased 13%. Mean anginal frequency declined, as did mean weekly sublingual nitroglycerin consumption, but not significantly. There were more cardiovascular side effects with nicardipine than with placebo, with at least 3 patients having increased angina judged by investigators as probably related to the drug. Vasodilatory side effects were also more frequent with nicardipine, but were generally mild and well tolerated; the drug had to be discontinued in only 1 patient, because of vasodilatory effects. Nicardipine is effective and generally well tolerated in patients with chronic stable angina.