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Long-term study of high-dose diltiazem in chronic stable exertional angina
Insights
Diltiazem significantly improved exercise capacity and reduced angina episodes in men with exertional angina. This calcium channel blocker demonstrated efficacy as a well-tolerated monotherapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Exertional angina is a condition characterized by chest pain during physical activity.
- Calcium channel blockers are a class of drugs used to treat cardiovascular conditions.
Purpose of the Study:
- To evaluate the efficacy of diltiazem as monotherapy for exertional angina.
- To compare the effects of diltiazem to placebo in patients with exertional angina.
Main Methods:
- A 21-week study involving 15 men with exertional angina.
- Symptom-limited exercise testing was employed to assess drug effects.
- Analysis of variance (ANOVA) was used for statistical analysis of time-related exercise variables.
Main Results:
- Diltiazem significantly increased time to angina onset, time to ST depression, and total exercise duration (p < 0.001).
- Weekly angina frequency decreased from 17 to 1 episode per week (p < 0.001).
- Diltiazem reduced submaximal pressure-rate product and ECG evidence of myocardial ischemia during exercise.
Conclusions:
- Diltiazem (360 mg/day) is effective as monotherapy for exertional angina.
- The drug was well-tolerated by study participants.
- Diltiazem improves exercise tolerance and reduces ischemic events in patients with exertional angina.
Abstract:
The efficacy of a calcium slow channel-blocking drug, diltiazem (360 mg/day), was compared to placebo in 15 men with exertional angina during a 21-week study. Symptom-limited exercise testing was used to evaluate the effects of the drug. Analysis of variance indicated the increase in the values of three time-related variables, time to onset of angina, time to onset of 1 mm ST depression, and total duration of exercise, were highly significant (all p less than 0.001). The increase from the second week of placebo to the last week of diltiazem was 4 X 1 minutes for time to angina, 2 X 4 minutes for time to 1 mm ST depression, and 2 X 3 minutes for total duration. In addition, the differences between mean values of these variables for placebo and corresponding diltiazem period at weeks 3 and 4 were significant (p less than 0.01, p less than 0.01, p less than 0.05) and for diltiazem week 20 and placebo week 21 were significant (p less than 0.005, p less than 0.01, p less than 0.005). Weekly angina frequency was reduced from a mean of 17 episodes/week during placebo to one episode/week during diltiazem (p less than 0.001). Submaximal pressure-rate product was reduced significantly during diltiazem (p less than 0.001), and the ECG evidence of myocardial ischemia was reduced by diltiazem at submaximal (p less than 0.02) and maximal exercise (p less than 0.001). The drug was well tolerated and appears to be effective monotherapy for exertional angina.