[Clinical value of degree of blood pressure lowering during use of effective doses of antianginal drugs].
Paired exercise tests with single doses of verapamil, nifedipine, propranolol, buccal nitroglycerin (trinitrolong), sustained release oral nitroglycerin, and placebo were performed in 101 patients with stable class II-III angina and the drug causing longest exercise duration was selected for long term therapy. Efficacy of a selected drug was compared with magnitude of its hypotensive effect. The latter was calculated as difference between blood pressure (BP) before and 2 hours after drug administration. Lower quintile of distribution of BP differences (systolic BP difference >20 mm Hg and/or diastolic BP difference >15 mm Hg) was considered as excessive hypotensive effect of a study drug (EHESD) single dose. Exercise duration before ST-segment depression was significantly shorter (p<0.05) in cases with EHESD compared with those without EHESD. After 1 month of therapy total daily number of episodes of myocardial ischemia decreased by 3.2+/-3.0 and 1.8+/-1.2 in patients without and with EHESD, respectively (p<0.02). At the same time number of episodes of painless ischemia increased more than 2 times in patients with EHESD (p<0.01). Registration of EHESD at initial stages of treatment with short acting antianginal drugs appears to be a reliable marker of increased frequency of painless episodes of myocardial ischemia and low efficacy of regular use of these drugs.
Bochkareva
E V
EV
Kokurina
E V
EV
Voronina
V P
VP
Kucheriavaia
N G
NG
Butina
E K
EK
D000328:Adult; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D009543:Nifedipine / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D005996:Nitroglycerin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D010919:Placebos; D011433:Propranolol / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D014700:Verapamil / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use
D010919:Placebos; D014665:Vasodilator Agents; D011433:Propranolol; D014700:Verapamil; D005996:Nitroglycerin; D009543:Nifedipine