TY - JOUR
T1 - Clinical efficacy of verapamil alone and combined with propranolol in treating patients with chronic stable angina pectoris
AU - Leon, Martin B.
AU - Rosing, Douglas R.
AU - Bonow, Robert O.
AU - Lipson, Lewis C.
AU - Epstein, Stephen E.
PY - 1981/7
Y1 - 1981/7
N2 - To determine the effectiveness of oral verapamil alone and combined with propranolol in patients with chronic angina pectoris, upright bicycle exercise testing was performed in 11 patients in an inpatient single blind crossover study. Compared with placebo, which resulted in an exercise time of 5.1 ± 0.7 minutes (mean ± standard error of the mean), verapamil (480 mg/day) improved exercise time in all patients (mean increment 3.4 ± 0.7 minutes, p <0.001) and was more effective than propranolol (160 to 320 mg/day) (mean increment 1.3 ± 0.6 minutes, p <0.005). Verapamil plus propranolol further increased exercise time (mean increment 4.7 ± 0.7 minutes, p <0.001 versus verapamil alone) and 9 (82 percent) of 11 patients were pain-free during exercise (in contrast to 2 of 11 with propranolol and 1 of 11 with verapamil). Time to 1 mm S-T segment depression was increased by both verapamil (p <0.005) and verapamil plus propranolol (p <0.05) compared with placebo. At the work load causing angina during the placebo study, verapamil decreased heart rate (from 112 ± 3 to 104 ± 3 beats/min, p <0.05) and decreased, but not significantly, pressure-rate product (from 18.3 ± 0.8 × 103 to 15.9 ± 0.9 × 103). Verapamil plus propranolol further decreased heart rate (to 76 ± 3, p <0.001) and pressure-rate product (to 9.7 ± 0.5 × 103, p <0.001). Adverse effects from verapamil, alone or with propranolol, included P-R interval prolongation in most patients, transient atrioventricular nodal Wenckebach block in one patient and exertional dyspnea, orthostatic dizziness or pedal edema in three others. Thus, in this study of patients with stable angina (1) verapamil was a more effective antianginal agent than propranolol, and (2) verapamil plus propranolol provided additional improvement in exercise capacity over either drug alone.
AB - To determine the effectiveness of oral verapamil alone and combined with propranolol in patients with chronic angina pectoris, upright bicycle exercise testing was performed in 11 patients in an inpatient single blind crossover study. Compared with placebo, which resulted in an exercise time of 5.1 ± 0.7 minutes (mean ± standard error of the mean), verapamil (480 mg/day) improved exercise time in all patients (mean increment 3.4 ± 0.7 minutes, p <0.001) and was more effective than propranolol (160 to 320 mg/day) (mean increment 1.3 ± 0.6 minutes, p <0.005). Verapamil plus propranolol further increased exercise time (mean increment 4.7 ± 0.7 minutes, p <0.001 versus verapamil alone) and 9 (82 percent) of 11 patients were pain-free during exercise (in contrast to 2 of 11 with propranolol and 1 of 11 with verapamil). Time to 1 mm S-T segment depression was increased by both verapamil (p <0.005) and verapamil plus propranolol (p <0.05) compared with placebo. At the work load causing angina during the placebo study, verapamil decreased heart rate (from 112 ± 3 to 104 ± 3 beats/min, p <0.05) and decreased, but not significantly, pressure-rate product (from 18.3 ± 0.8 × 103 to 15.9 ± 0.9 × 103). Verapamil plus propranolol further decreased heart rate (to 76 ± 3, p <0.001) and pressure-rate product (to 9.7 ± 0.5 × 103, p <0.001). Adverse effects from verapamil, alone or with propranolol, included P-R interval prolongation in most patients, transient atrioventricular nodal Wenckebach block in one patient and exertional dyspnea, orthostatic dizziness or pedal edema in three others. Thus, in this study of patients with stable angina (1) verapamil was a more effective antianginal agent than propranolol, and (2) verapamil plus propranolol provided additional improvement in exercise capacity over either drug alone.
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U2 - 10.1016/0002-9149(81)90582-8
DO - 10.1016/0002-9149(81)90582-8
M3 - Article
C2 - 7246435
AN - SCOPUS:0019430087
VL - 48
SP - 131
EP - 139
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 1
ER -