Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort: a randomized, double-blind,...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Severe angina of effort often requires combination therapy for optimal management.
• Patients with persistent angina despite propranolol therapy may benefit from additional agents.

Purpose of the Study:

• To compare the efficacy and safety of propranolol-verapamil versus propranolol-nifedipine in patients with severe angina of effort.
• To evaluate the impact of these combinations on anginal symptoms, nitroglycerin usage, exercise tolerance, and cardiac function.

Main Methods:

• A double-blind, randomized study involving 16 patients with severe angina.
• Patients received propranolol plus verapamil (360 mg/day) or nifedipine (60 mg/day) for 3 weeks each, in addition to their existing propranolol dose.

Main Results:

• Propranolol-verapamil significantly reduced anginal frequency and nitroglycerin use compared to propranolol alone; propranolol-nifedipine did not.
• ST-segment depression at peak exercise was significantly less with propranolol-verapamil than with propranolol alone or propranolol-nifedipine.
• Left ventricular ejection fraction at rest was higher with propranolol-nifedipine than with propranolol-verapamil, but neither differed from propranolol alone.

Conclusions:

• Propranolol-verapamil is more effective than propranolol-nifedipine in reducing anginal symptoms and improving exercise-induced ischemia in patients with severe angina of effort.
• Verapamil, while effective, may cause side effects such as bradycardia, necessitating dosage adjustment.