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Long-term persistence of antianginal effect of oral verapamil in chronic stable angina
Insights
Verapamil effectively treats effort-induced angina for up to one year, maintaining short-term benefits. This study found verapamil safe and well-tolerated in patients receiving continuous treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Effort-induced angina significantly impacts patient quality of life.
- Long-term efficacy and safety data for verapamil in angina management are crucial.
Purpose of the Study:
- To assess the long-term antianginal effect of orally administered verapamil over one year.
- To evaluate the sustained efficacy and safety of verapamil in patients with effort-induced angina.
Main Methods:
- A randomized, placebo-controlled short-term phase followed by a one-year continuous treatment phase.
- Patients underwent bicycle exercise tests to measure tolerated workload.
- Verapamil and norverapamil plasma levels were monitored.
Main Results:
- Verapamil significantly increased tolerated workload compared to placebo in the short-term phase.
- The antianginal effects observed in the short-term phase were sustained throughout the one-year treatment period.
- Verapamil was well-tolerated, with mild constipation and slight P-R interval prolongation being the main side effects; no heart failure or AV block occurred.
Conclusions:
- Oral verapamil demonstrates sustained efficacy and a favorable safety profile for the long-term management of effort-induced angina.
- The beneficial effects of verapamil in improving exercise tolerance are maintained with continuous one-year treatment.
- Verapamil is an effective and safe therapeutic option for patients suffering from effort-induced angina.
Abstract:
The long-term antianginal effect of orally administered verapamil over 1 year of continuous treatment was assessed in 11 patients with effort-induced angina. In the short-term phase of the study, patients were given, in random order, placebo and verapamil (360 mg/day). The tolerated work load during a bicycle exercise test was 531.8 +/- 123.0 kg/min on placebo and 763.6 +/- 124.7 kg/min on verapamil (p less than 0.001). Subsequently all patients entered a long-term study of 1-year continuous treatment with 120 mg t.i.d. verapamil. The tolerated work load at 8-week (736.4 +/- 105.1 kg/min) and 1-year (804.6 +/- 101.1 kg/min) tests did not significantly differ from the results in the short-term study. The average verapamil plasma level was 138.5 +/- 90.6 ng/ml before and 357.8 +/- 199.2 ng/ml 90 min after drug administration; the average norverapamil plasma levels were, respectively, 248.0 +/- 84.4 and 368.0 +/- 135.9 ng/ml. There was no correlation between verapamil or norverapamil plasma concentrations and the antianginal effect. No patient developed signs of heart failure during the treatment. Two patients had mild constipation. The average P-R interval was slightly, although significantly (p less than 0.01) prolonged, but no patient developed first-degree atrioventricular block. We conclude that verapamil proves an effective and safe drug in the treatment of effort-induced angina; the beneficial effects of the short-term treatment are sustained during 1 year of continuous treatment.