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Long-term efficacy of diltiazem assessed with multistage graded exercise tests in patients with chronic stable angina
Insights
Long-term diltiazem therapy significantly improved exercise tolerance in patients with stable exertional angina. Diltiazem demonstrated sustained efficacy over 52 weeks, though some patients required additional treatments or experienced adverse effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable exertional angina pectoris affects patient quality of life.
- Assessing long-term treatment efficacy is crucial for managing angina.
Purpose of the Study:
- To evaluate the long-term efficacy of diltiazem (360 mg/day) in patients with stable exertional angina.
- To assess the safety and tolerability of continuous diltiazem therapy over 52 weeks.
Main Methods:
- A placebo-controlled, double-blind, dose-titration study.
- Seventeen patients with Canadian Cardiovascular Society grade II or III stable exertional angina.
- Multistage graded exercise tests were conducted at baseline, and after 6, 18, 26, 40, and 52 weeks of diltiazem therapy.
Main Results:
- Diltiazem significantly increased exercise time compared to placebo (p < 0.001).
- Exercise time improved from 5.8 minutes with placebo to over 11 minutes throughout the 52-week treatment period.
- Four patients withdrew due to need for surgery or additional medications; one experienced a rash, and others reported musculoskeletal discomfort.
Conclusions:
- Diltiazem, 360 mg/day, is effective for long-term management of stable exertional angina.
- Sustained improvement in exercise capacity was observed over 52 weeks.
- While generally well-tolerated, monitoring for adverse effects and potential need for combination therapy is advised.
Abstract:
The long-term efficacy of diltiazem, 360 mg/day, in patients with grade II or III stable exertional angina pectoris (Canadian Cardiovascular Society criteria) was assessed by multistage graded exercise tests. Seventeen patients undertook a placebo-controlled, double-blind, dose-titration protocol and all received long-term therapy. Exercise tests were performed at the end of 2 weeks of placebo treatment and after 6, 18, 26, 40 and 52 weeks of diltiazem, 360 mg/day. All patients had angina during treadmill testing with placebo and the mean (+/- standard error of the mean) exercise time was 5.8 +/- 0.7 minutes. This increased to 10.8 +/- 1.0 minutes after 6 weeks, 11.3 +/- 1.1 minutes after 18 weeks, 11.4 +/- 1.1 minutes after 26 weeks, 12.9 +/- 1.2 minutes after 40 weeks and 11.6 +/- 1.3 minutes after 52 weeks of continuous diltiazem therapy (p less than 0.001 vs placebo at all stages). Four patients were withdrawn after 26 weeks of treatment; one patient underwent coronary artery bypass surgery and 3 patients required the addition of beta-adrenoreceptor blocking agents. In 1 patient an irritant rash developed on the torso, legs and arms after 39 weeks of diltiazem and disappeared after discontinuing the drug. One patient complained of swelling and stiffness of the fingers and 3 patients complained of shoulder and elbow pain. Another patient had a myocardial infarction after 8 weeks of diltiazem treatment and died. No other adverse effects were observed during this study.(ABSTRACT TRUNCATED AT 250 WORDS)