[Antianginal effect of calcium antagonists, using nisoldipine as an example]

The antianginal effect of nisoldipine was studied in 10 patients (mean age 52.3 years) with coronary artery disease. All patients developed ST-depression during bicycle exercise stress test and 7/10 patients had angina pectoris. The exercise test was stopped after a mean duration of 2.6 min at a work load of 117 watts (calculated working capacity 151 watts). Two hours after oral administration of 10 mg nisoldipine the bicycle exercise stress test was repeated at the same work load as during control. Only 3/10 patients had angina pectoris during the second stress test. After nisoldipine the resting heart rate was significantly higher (76 vs. 67 beats/min; p less than 0.05), systolic blood pressure was slightly lower (122 vs. 130 mm Hg; not significant) and diastolic blood pressure significantly lower (75 vs. 84 mm Hg; p less than 0.01) as compared to the control state. During exercise, heart rate (124 vs. 124 beats/min) and systolic/diastolic blood pressure (148/78 vs. 161/83 mm Hg) were not significantly different from control. However, ST-depression was significantly reduced (0.14 vs. 0.26 mV; p less than 0.001) after nisoldipine. Thus, nisoldipine shows a beneficial effect in patients with coronary artery disease by reduction of exercise-induced myocardial ischemia and improved exercise tolerance. The decrease in blood pressure and the increase in heart rate in the resting state are due to peripheral vasodilatation with afterload reduction.