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Concomitant calcium antagonist plus isosorbide dinitrate therapy for markedly active variant angina
Insights
Combination therapy with calcium antagonists (verapamil or nifedipine) and isosorbide dinitrate significantly reduced angina episodes and ST segment deviations in variant angina patients compared to isosorbide dinitrate alone.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Variant angina (Prinzmetal's angina) is characterized by coronary artery spasms leading to chest pain.
- Isosorbide dinitrate is a common treatment, but its efficacy alone can be limited in severe cases.
Purpose of the Study:
- To evaluate the effectiveness of combining calcium antagonists (verapamil, nifedipine) with isosorbide dinitrate for variant angina.
- To compare this combination therapy against isosorbide dinitrate monotherapy.
Main Methods:
- Nine patients with frequent variant angina episodes were enrolled.
- A long-term comparison involved three treatment phases: isosorbide dinitrate alone, verapamil + isosorbide dinitrate, and nifedipine + isosorbide dinitrate, each for two months.
- Efficacy was assessed by weekly frequency of chest pain, sublingual nitroglycerin use, and Holter-monitored ST segment deviations.
Main Results:
- Isosorbide dinitrate monotherapy showed high frequencies of angina and ST deviations.
- Combination therapy with verapamil/isosorbide dinitrate and nifedipine/isosorbide dinitrate dramatically reduced both angina episodes and ST segment deviations (p < 0.05).
- Both combination therapies demonstrated similar efficacy.
Conclusions:
- Concomitant use of calcium antagonists with isosorbide dinitrate is highly effective in managing variant angina.
- Combination therapy offers a significant improvement over isosorbide dinitrate monotherapy for patients with frequent angina episodes.
Abstract:
The present study was performed to assess the efficacy of concomitant calcium antagonist/isosorbide dinitrate therapy in patients with frequent episodes of variant angina and to compare such combination therapy with isosorbide dinitrate alone. We enrolled nine such patients (six men and three women, aged 47 +/- 9 [mean +/- standard deviation] years) in a long-term comparison of (1) oral isosorbide dinitrate (117 +/- 63 mg per day) alone, (2) verapamil (453 +/- 75 mg per day) + isosorbide dinitrate (given in the same dose as stated above), and (3) nifedipine (71 +/- 14 mg per day) + isosorbide dinitrate (also given in the same dose as stated), each administered for 2 months. During isosorbide dinitrate therapy, these nine patients averaged 23.7 +/- 37.3 chest pains per week, consumed 24.4 +/- 47.4 sublingual nitroglycerin tablets per week, and demonstrated 46.5 +/- 43.2 episodes per week of transient ST segment deviations on calibrated two-channel Holter monitoring. During therapy with verapamil/isosorbide dinitrate and nifedipine/isosorbide dinitrate, the frequency of angina and ST segment deviations was dramatically reduced (verapamil/isosorbide dinitrate, 3.9 +/- 3.6 chest pains per week and 3.5 +/- 2.6 ST segment deviations per week, p less than 0.05; nifedipine/isosorbide dinitrate, 3.1 +/- 4.0 chest pains per week and 5.5 +/- 6.6 ST segment deviations per week, p less than 0.05). In all respects, verapamil/isosorbide dinitrate and nifedipine/isosorbide dinitrate were similar to one another.(ABSTRACT TRUNCATED AT 250 WORDS)