title: Efficacy of ivabradine in combination with Beta-blocker versus uptitration of Beta-blocker in patients with stable angina.
abstract: OBJECTIVE
  The antianginal and anti-ischemic efficacy of the selective I                            (f) inhibitor ivabradine is established in patients with stable angina in monotherapy and in combination with other antianginals, including beta-blocker. This pilot study compared the antianginal and anti-ischemic efficacy and hemodynamic profile of ivabradine plus 5 mg bisoprolol versus those of 10 mg bisoprolol in patients with stable angina.
  
  
  METHODS
  Twenty-nine patients with stable angina and moderate left ventricular systolic dysfunction already on bisoprolol 5 mg od were randomized into 2 groups. Group 1 (n = 17) received ivabradine (5-7.5 mg bid) in addition to bisoprolol 5 mg od, while in group 2 (n = 12) bisoprolol was uptitrated first to 7.5 mg and then 10 mg od. Patients underwent a treadmill test, 6-minute walking test, and echocardiography at baseline and after 2 months.
  
  
  RESULTS
  Mean resting heart rate decreased in both groups, from 76.6 ± 4.6 bpm to 59.3 ± 2.5 bpm (P < 0.001) in group 1 and from 75.9 ± 3.0 bpm to 60.5 ± 2.3 bpm (P = 0.002) in group 2. The effect on resting heart rate did not differ significantly between the two groups. However, more patients became asymptomatic in group 1 than in group 2. Addition of ivabradine also improved exercise capacity, as shown by the results of the 6-minute walking and exercise tolerance tests, whereas in group 2 neither parameter was significantly affected. Chronotropic reserve significantly improved with ivabradine, but not with bisoprolol 10 mg.
  
  
  CONCLUSIONS
  These results suggest that combining ivabradine with low dose bisoprolol in stable angina patients produces additional antianginal and anti-ischemic benefits and improves chronotropic reserve.
authors.affiliation: National Medical University, Kiev, Ukraine.
authors.forename: E
authors.initials: E
authors.lastname: Amosova
authors.forename: E
authors.initials: E
authors.lastname: Andrejev
authors.forename: I
authors.initials: I
authors.lastname: Zaderey
authors.forename: U
authors.initials: U
authors.lastname: Rudenko
authors.forename: C
authors.initials: C
authors.lastname: Ceconi
authors.forename: R
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D060050:Angina, Stable / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D017298:Bisoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D054815:Cyclic Nucleotide-Gated Cation Channels / Q000037:antagonists & inhibitors; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test / Q000187:drug effects; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001552:Benzazepines; D054815:Cyclic Nucleotide-Gated Cation Channels; D000077550:Ivabradine; D017298:Bisoprolol