Objective evaluation of three dose levels of diltiazem in patients with chronic stable angina
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Diltiazem effectively treats chronic stable angina, with the 360 mg/day dose showing the best results in improving exercise tolerance and reducing anginal attacks. This calcium antagonist offers significant therapeutic benefits without negatively impacting left ventricular function.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina is a prevalent condition requiring effective treatment.
- Calcium antagonists represent a key therapeutic class for managing angina.
Purpose of the Study:
- To evaluate the efficacy and optimal dosage of diltiazem in patients with chronic stable angina.
- To assess the impact of varying diltiazem doses on exercise tolerance and anginal symptoms.
Main Methods:
- A blinded, objective protocol was used to titrate diltiazem dosage (180, 270, 360 mg/day) in 21 patients.
- Exercise tolerance, anginal attack frequency, nitroglycerin consumption, and Holter monitoring were assessed.
- Left ventricular function was evaluated at all dose levels.
Main Results:
- Diltiazem improved exercise tolerance at all tested doses.
- The 360 mg/day dose demonstrated the most significant reduction in anginal attacks and nitroglycerin use.
- Exercise time to angina increased significantly with diltiazem, particularly at the 360 mg/day dose (9.5 minutes vs. 5.6 minutes placebo).
- No adverse effects on left ventricular function were observed.
Conclusions:
- Diltiazem, at doses from 180 to 360 mg/day, is a potent antianginal agent for chronic stable angina.
- The 360 mg/day dose provides optimal therapeutic benefits.
- Diltiazem is well-tolerated and does not impair left ventricular function.
Abstract:
Twenty-one patients with chronic stable angina were treated with the calcium antagonist diltiazem. Dose titration studies involving 180, 270 and 360 mg/day were conducted using a blinded objective protocol. Improvement in exercise tolerance was observed at all dose levels, but the best reduction of anginal attacks and glyceryl trinitrate consumption, enhancement of exercise capacity and improvement of objective ischemic variables were observed with the 360 mg/day dose. The mean exercise time to produce grade II angina on treadmill walking increased from 5.6 +/- 0.7 minutes on placebo to 7.9 +/- 0.8 minutes on diltiazem 180 mg/day (probability [p] less than 0.001), 8.0 +/- 0.8 minutes on 270 mg/day and 9.5 +/- 0.9 minutes on 360 mg/day (p less than 0.001 as compared with 270 mg/day). One patient was withdrawn at the 360 mg/day dosage because of pedal edema. The 24 hour Holter monitoring data confirmed the findings on exercise testing, and left ventricular function was not altered with any dose level. Diltiazem in doses ranging from 180 to 360 mg/day is another powerful antianginal agent in the calcium antagonist group producing excellent therapeutic benefit in chronic stable angina with no adverse effects on left ventricular function.