[Acute effects of propranolol and its association with nifedipine in aged patients with effort stable angina. Randomized double-blind crossover study, under placebo control].
Calcium-antagonist and B-blockers are effective in improving exercise tolerance in patients with effort angina. We studied the short effects of oral administration of nifedipine (10 mg) and propranolol (80 mg) alone and in combination in 15 elderly patients with chronic exertional angina pectoris in a double-blind, randomized, cross-over study. The 15 patients (13 men and 2 women, mean age 69 years) performed symptoms-limits bicycle exercise stress test 3 h after placebo or active substance administration. Maximal work load, exercise duration, real time to 1 mm ST segment depression were significantly increased and ST depression at peak exercise was significantly decreased by drug alone and in combination. Propranolol and nifedipine improved exercise duration in combination; however, a different response to the three pharmacologic interventions was found in patients treated with single drug. The improvement in exercises tolerance was associated with rate-pressure product values at peak exercise tolerance was associated with rate-pressure product values at peak exercise, unchanged after placebo and significantly reduced after both propranolol alone and in combination. After placebo all patients had exercise-induced angina, in 50% and in 40% after propranolol and the combination of the two drugs, respectively. In aging patients nifedipine and propranolol are effective in the treatment of effort angina and they are superior in patients who show poor response to mono therapy, although this combination will be conditioned by different patient sensibility to the three pharmacologic interventions and then therapeutic choice would be evaluated and verified individually.
Santamaria
F
F
Cattedra di Gerontologia e Geriatria, II Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli.
Sestito
M
M
Lirato
C
C
Di Palma
A
A
De Rosa
M L
ML
Iannuzzi
L
L
Pandolfi
E
E
Cicatiello
A M
AM
Parlati
S
S
D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D009543:Nifedipine / Q000494:pharmacology / Q000627:therapeutic use*; D010919:Placebos; D011433:Propranolol / Q000494:pharmacology / Q000627:therapeutic use*
D010919:Placebos; D011433:Propranolol; D009543:Nifedipine
Effetti acuti del propranololo e sua associazione con nifedipina in pazienti anziani con angina stabile da sforzo. Studio a doppio cieco, randomizzato, cross-over, controllato con placebo.