The efficacy and safety of high-dose verapamil and diltiazem in the long-term treatment of stable exertional angina.
The efficacy and safety of high-dose verapamil (480 mg/day) and diltiazem therapy (360 mg/day) were compared in separate cohorts of 26 and 20 patients, respectively. All patients had stable exertional angina and underwent an initial 6-week double-blind, placebo-controlled, randomized phase followed by a 12-month open-label period. Angina attacks were reduced by verapamil (6.3 +/- 7.5 to 2.5 +/- 4.1 attacks per week, p less than 0.001) and by diltiazem (9.2 +/- 7.5 to 3.0 +/- 3.1 attacks per week, p less than 0.001), while treadmill time increased with both verapamil (372 +/- 132 to 444 +/- 108 s, p less than 0.001) and diltiazem (412 +/- 175 to 536 +/- 164 s, p less than 0.001) during the short-term study. Both agents continued to show similar salutory effects at the end of one year. The beneficial effects of both drugs appeared to be related in part to a reduction of the rate-pressure product during submaximal exercise (12% by verapamil, 7% by diltiazem, both p less than 0.05). Adverse effects were few and consisted primarily of mild constipation in six patients taking verapamil, and pedal edema and transient flushing in 2 patients each using diltiazem. Thus, high-dose verapamil and diltiazem have similar beneficial effects and are safe for the long-term treatment of effort-related angina pectoris.
D000787:Angina Pectoris / Q000188:drug therapy*; D001552:Benzazepines / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D004110:Diltiazem / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D004311:Double-Blind Method; D004562:Electrocardiography; D005080:Exercise Test; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000187:drug effects; D011897:Random Allocation; D013997:Time Factors; D014700:Verapamil / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
D001552:Benzazepines; D014700:Verapamil; D004110:Diltiazem