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Therapy for angina pectoris: comparison of nicardipine with other antianginal agents
1Division of Cardiology, New York Hospital-Cornell Medical Center, NY 10021.
Insights
Nicardipine, a dihydropyridine calcium channel blocker, effectively treats chronic stable angina by improving exercise tolerance and reducing angina episodes. It demonstrates comparable efficacy to other treatments with generally mild side effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina remains a significant cardiovascular condition.
- Dihydropyridine calcium channel blockers are a key therapeutic class.
Purpose of the Study:
- To evaluate the efficacy and safety of nicardipine for chronic stable angina.
- To compare nicardipine with placebo, other calcium channel blockers, and beta blockers.
Main Methods:
- Review of hemodynamic studies in patients with coronary artery disease.
- Analysis of three controlled clinical trials using nicardipine monotherapy.
- Examination of five trials comparing nicardipine with other calcium channel blockers and three with beta blockers.
Main Results:
- Nicardipine exhibits significant coronary and systemic vasodilator actions with minimal negative inotropic effect.
- Monotherapy trials showed a 20-30% increase in exercise time and reduction in angina.
- Comparative trials indicated efficacy equivalent to other calcium channel blockers and beta blockers.
Conclusions:
- Nicardipine is a useful agent for managing chronic stable angina.
- Adverse effects are typically mild, related to vasodilation, and often transient.
- Long-term use is generally well-tolerated with rare withdrawals due to side effects.
Abstract:
Nicardipine is a new dihydropyridine calcium channel blocking drug with actions that suggest considerable usefulness as an agent for chronic stable angina. Hemodynamic studies in patients with coronary artery disease confirm major coronary vasodilator actions, perhaps even exceeding its considerable systemic vasodilator properties with little or no negative inotropic effect. Three recent controlled clinical trials that used nicardipine alone suggest approximately 20% to 30% increase in exercise time, and at least that much decrease in anginal episodes and sublingual nitroglycerin consumption when compared with placebo in doses of 90 to 120 mg daily. Five trials comparing nicardipine with other calcium channel blockers, and three with beta blockers, suggest equivalent efficacy, including decrease in angina and increase in exercise time. Adverse effects of nicardipine generally relate to its potent vasodilatory capability and are usually minor. Side effects are frequent at the beginning of many trials, usually do not cause undue withdrawals, and are quite rare after 6 to 12 months on the drug in most studies.