Efficacy of monotherapy compared with combined antianginal drugs in the treatment of chronic stable angina pectoris: a meta-analysis.
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.
Klein
Werner W
WW
Department of Medicine, Karl Franzens University of Graz, Graz, Austria.
Jackson
Graham
G
Tavazzi
Luigi
L
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
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers