[Comparative effect of anti-anginal drugs on myocardial ischemia in patient with effort angina: evaluation by ambulatory electrocardiographic monitoring].
The purpose of this study was to compare the efficacy of three standard antianginal agents, nitrate, Ca antagonist, and beta blocker on myocardial ischemia in patients with effort angina (EA) using ambulatory electrocardiographic monitoring (AEM). Forty-three patients, mean age 57 +/- 11 years, with positive exercise tests were studied. AEM was performed for 24-hours, initially with the patients off all antianginal medication and then after 1-2 weeks treatment with each agent. Antianginal drugs used were long-acting isosorbide dinitrate 40-80 mg/day for nitrate (17 patients), diltiazem 90-180 mg/day for Ca antagonist (13 patients), and propranolol 30-60 mg/day or metoprolol 60-120 mg/day for beta blocker (13 patients). The following results were obtained: 1) The severity of ischemia (total magnitude and duration of ST depression) was improved with each three agent. 2) Although the number of total ischemic episodes was reduced significantly with each three agent, the number of asymptomatic episodes was reduced significantly only with beta blocker. 3) Circadian variation of ischemic episodes displayed a pattern with a peak frequency in daytime. In addition, nitrate and Ca antagonist did not reduce ischemic episodes in daytime (especially asymptomatic episodes), while beta blocker reduced both symptomatic and asymptomatic episodes in daytime resulting in change in the pattern of circadian variation of ischemia. Thus, it was concluded that beta blocker was the most effective means of reducing myocardial ischemia, including silent ischemia, in patients with EA.
Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
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Suzuki
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002940:Circadian Rhythm; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D003692:Delayed-Action Preparations; D004110:Diltiazem / Q000627:therapeutic use; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D011433:Propranolol; D004110:Diltiazem; D007548:Isosorbide Dinitrate