Nifedipine versus propranolol treatment for unstable angina in the elderly

The effectiveness of nifedipine versus propranolol monotherapy in the treatment of unstable angina in the elderly was evaluated in 26 patients over age 65 years. The study utilized a randomized, parallel design with double-blind primary outcome measurements. Subjects (mean, 76 +/- 2 years) were allocated to nifedipine (n = 12) 10, 20 and 30 mg tid or propranolol (n = 14) 20, 40 and 80 mg tid with the dose increased at 24 to 72 h intervals if tolerated. Maintenance therapy was continued for three months. Unstable angina or myocardial infarction occurred in seven of 12 nifedipine patients versus two of 14 patients on propranolol (P = 0.025). The drugs were similar with respect to daily nitroglycerin use, treadmill walking time and left ventricular ejection fraction. Drug intolerance occurred in two patients on nifedipine and four on propranolol. Propranolol, if tolerated, appears to be more effective than nifedipine in preventing recurrent unstable angina or myocardial infarction in elderly patients.