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1Klinikum Grosshadern, Medizinische Klinik I, München, Federal Republic of Germany.
Insights
Isosorbide-5-mononitrate (IS-5-MN) and nifedipine effectively reduced transient ischemic episodes in coronary heart disease patients. Both treatments significantly lowered painful and painless episodes, though individual responses varied.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary heart disease patients experience spontaneous transient ischemic episodes, often without pain.
- Continuous Holter monitoring is crucial for detecting these episodes.
Purpose of the Study:
- To compare the efficacy of isosorbide-5-mononitrate (IS-5-MN) and nifedipine in reducing transient ischemic episodes.
- To assess the impact of these drugs on both painful and painless ischemic events.
Main Methods:
- A controlled, double-blind trial involving 20 coronary heart disease patients with documented transient ischemic episodes.
- Patients received IS-5-MN or nifedipine in a randomized order over four 1-week periods, with Holter monitoring conducted weekly.
- Ischemic episodes were defined as ST deviation >1 mm for >1 minute on electrocardiogram.
Main Results:
- Both IS-5-MN and nifedipine significantly reduced ischemic episodes (p < 0.05).
- IS-5-MN therapy showed episode reductions of 67%, while nifedipine showed 56-58% reductions.
- Painful and painless episodes were reduced similarly, but not all patients were episode-free, and some showed no response.
Conclusions:
- IS-5-MN and nifedipine are effective in reducing transient ischemic episodes in coronary heart disease.
- Treatment efficacy varies among individuals, highlighting the need for personalized therapeutic approaches.
- Further research may be needed to optimize treatment for non-responders.
Abstract:
Continuous Holter monitoring of patients with coronary heart disease can show transient ischemic episodes occurring spontaneously with or without angina throughout the day. A controlled double-blind trial was conducted comparing the effects of isosorbide-5-mononitrate (IS-5-MN) and nifedipine in patients with documented transient ischemic episodes. Seventy-five percent of the ischemic episodes were not accompanied by pain. Twenty patients with documented coronary heart disease were included; 15 finished the 4-week study (1 patient had headaches, 1 thyrotoxicosis, 1 hypertensive crisis and 2 unstable angina). On a dual-channel FM-recorded electrocardiogram, ischemic episodes were counted when ST deviation was greater than 1 mm for greater than 1 minute. Patients received IS-5-MN (20 mg 3 times a day or 50 mg in a sustained-release tablet) or nifedipine (20 mg in a sustained-release tablet 3 times a day) in random order over four 1-week periods. At the end of each week, Holter monitoring was repeated and showed reductions of episodes by 67% and 67% after weeks of IS-5-MN therapy and 56% and 58% after weeks of nifedipine therapy (all p less than 0.05). Painful and painless episodes were reduced to a similar extent. Individual responses showed great variability, and in all treatment periods not more than half of the patients were completely free of ischemic episodes. One of the 12 patients did not respond to either way of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)