title: Comparative effects of prolonged therapy with four calcium ion antagonists (diltiazem, nicardipine, tiapamil and verapamil) in patients with chronic stable angina pectoris.
abstract: The comparative effects of prolonged chronic therapy with diltiazem, nicardipine, tiapamil and verapamil on exercise tolerance, ST-segment changes and heart rate were examined in 63 patients with established chronic stable angina pectoris. Multistage computer-assisted symptom-limited treadmill exercise tests were performed after 2 weeks of placebo ("baseline") and then after 4 months of open-label chronic drug therapy. Diltiazem improved the exercise duration by 95% (p less than 0.001), nicardipine by 45% (p less than 0.001), tiapamil by 69% and verapamil by 79% (p less than 0.001). Maximal ST-segment depression was not altered by any of the drugs, but time to the development of 1 mm ST-segment depression was significantly improved in all cases. Diltiazem and verapamil reduced the heart rate at rest significantly by 6 and 8 beats/minute, respectively, whereas nicardipine increased it by 10 beats/minute (p less than 0.02), and tiapamil did not produce any significant change. Maximal heart rate at the peak of exercise was increased by 14% with nicardipine (p less than 0.001) and 6% with verapamil (p less than 0.05), whereas diltiazem and tiapamil did not produce any appreciable effect. The rate-pressure product at the peak of exercise remained unaltered with diltiazem, tiapamil and verapamil, but with nicardipine it increased significantly to 222 +/- 10 units from a baseline of 175 +/- 6 units with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Cardiology, Northwick Park Hospital, Harrow, Middlesex, England.
authors.forename: N S
authors.initials: NS
authors.lastname: Khurmi
authors.forename: E B
authors.initials: EB
authors.lastname: Raftery
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002908:Chronic Disease; D004110:Diltiazem / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use; D011437:Propylamines / Q000627:therapeutic use; D013976:Tiapamil Hydrochloride; D014700:Verapamil / Q000627:therapeutic use
chemical_list: D002121:Calcium Channel Blockers; D011437:Propylamines; D014700:Verapamil; D009529:Nicardipine; D004110:Diltiazem; D013976:Tiapamil Hydrochloride