Combination propranolol and bepridil therapy in stable angina pectoris

Area of Science:

• Cardiology
• Pharmacology

Background:

• Patients with angina unresponsive to propranolol alone require alternative treatment strategies.
• Beta-blockers like propranolol are a cornerstone of angina management.
• Investigating combination therapies can reveal synergistic effects for improved patient outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of adding bepridil to propranolol therapy in patients with refractory angina.
• To compare the combination therapy against placebo plus propranolol in a double-blind, randomized trial.

Main Methods:

• A double-blind, placebo-controlled, parallel-design trial involving 56 patients.
• Patients received either bepridil plus propranolol or placebo plus propranolol for 8 weeks after an initial 2-week placebo run-in.
• Assessed outcomes included angina attack frequency, nitroglycerin consumption, exercise performance (Bruce protocol), and Holter ECG.

Main Results:

• Bepridil addition to propranolol significantly improved antianginal efficacy and reduced nitroglycerin consumption (p < 0.01).
• Combination therapy led to a significant increase in exercise tolerance (1.0 min vs. 0.02 min, p < 0.01) compared to placebo.
• Increased exercise time to angina onset (p < 0.04) and ST-segment depression (p < 0.06), along with total work (p < 0.03), were observed with bepridil plus propranolol.

Conclusions:

• Bepridil in combination with propranolol is a safe and effective treatment for patients with angina refractory to propranolol monotherapy.
• The combination therapy offers significant benefits in exercise capacity and symptom relief.
• Further research may explore optimal dosing and long-term safety profiles.