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Antianginal response to once-daily diltiazem CD in patients receiving concomitant beta-blockers, long-acting
G V Heller1, M Sridharan, J Morse
1Division of Cardiology, Hartford Hospital, Connecticut 06102, USA.
Insights
Diltiazem CD 180 mg effectively improved exercise tolerance and reduced angina in patients with chronic stable angina. This study found diltiazem CD to be a safe and beneficial addition to existing antianginal therapies.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic stable angina requires effective management beyond standard therapies.
- Beta-blockers and long-acting nitrates are common treatments, but some patients remain inadequately controlled.
Purpose of the Study:
- To evaluate the safety and efficacy of diltiazem CD 180 mg once daily.
- To assess its benefit as an add-on therapy for chronic stable angina.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled trial.
- 172 patients with inadequately controlled angina received diltiazem CD 180 mg or placebo daily.
- Treatment was added to existing antianginal therapy for 2 weeks.
Main Results:
- Diltiazem CD significantly increased exercise tolerance time and time to angina onset/severity (p<0.05).
- Reduced rates of total and exertional angina attacks were observed with diltiazem CD (p<0.05).
- Significant reductions in blood pressure and heart rate-blood pressure product were noted, with similar adverse event rates (15.1%) between groups.
Conclusions:
- Diltiazem CD 180 mg once daily is effective and safe.
- It offers a beneficial initial dosage option when added to existing antianginal regimens.
Study Objective:
To determine the safety and efficacy of diltiazem CD 180 mg administered once/day in patients with chronic stable angina inadequately controlled with P-blockers, long-acting nitrates, or both.
Design:
Multicenter, randomized, double-blind, placebo-controlled, parallel-group trial.
Setting:
Medical clinics in the private and academic sectors.
Patients:
Of 172 patients, 170 completed the 2-week double-blind treatment period.
Intervention:
. Patients received either diltiazem CD 180 mg or placebo once/day in combination with existing antianginal therapy.
Measurements And Main Results:
The time to termination of exercise tolerance testing, 24 hours after the dose increased significantly in the diltiazem CD group (37.2 sec) compared with the placebo group (21.3 sec, p=0.0438). Time to onset of angina during exercise testing also increased (57.6 vs 35.0 sec, respectively, p=0.0324), as did time to moderate angina (37.5 vs 20.6 sec, respectively, p=0.0354). The rates of total angina attacks and of angina attacks on exertion were significantly reduced in the diltiazem CD group versus placebo (p<0.05). Significant reductions in systolic and diastolic blood pressures and heart rate-blood pressure product measured at rest, submaximum exercise, and exercise termination were observed in diltiazem CD-treated patients compared with placebo (p<0.05). The frequency of treatment-related adverse events was identical in the two groups, 15.1%.
Conclusion:
Diltiazem CD 180 mg once/day is an effective, safe, and beneficial initial dosage when added to existing antianginal therapy.