title: Efficacy of monotherapy compared with combined antianginal drugs in the treatment of chronic stable angina pectoris: a meta-analysis.
abstract: OBJECTIVE
  To determine the relative efficacy of antianginal drugs administered as monotherapy or in combination in patients with chronic stable angina.
  
  
  METHODS
  A meta-analysis was performed on randomized trials, published in English between 1980 and 1999, that directly compared combined treatment and monotherapy. Twenty-two articles were included, all on the comparison of -blocker monotherapies to their combination with a calcium antagonist and 10 on the comparison of calcium antagonist monotherapies to their combination with a -blocker.
  
  
  RESULTS
  Time to 1 mm ST-segment depression, total exercise duration and time to onset of anginal pain were significantly increased with the combined therapy compared to -blocker alone (by 8, 5 and 12%, respectively). Only time to 1 mm ST-segment depression was significantly increased with the combined therapy compared to calcium antagonist alone (by 9%). For all these parameters, the adjusted differences were significant only within 6 h following drug intake and were not significant after 6 h. No analysis of safety data could be performed.
  
  
  CONCLUSIONS
  As far as exercise testing is concerned, the combination of a calcium antagonist and a -blocker is statistically more effective than either monotherapy. Further studies are needed to confirm the higher efficacy after the first 6 h following drug intake.
authors.affiliation: Department of Medicine, Karl Franzens University of Graz, Graz, Austria.
authors.forename: Werner W
authors.initials: WW
authors.lastname: Klein
authors.forename: Graham
authors.initials: G
authors.lastname: Jackson
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002908:Chronic Disease; D017023:Coronary Angiography; D018592:Cross-Over Studies; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers