title: [Triple antianginal combinations in the treatment of elderly and senile patients with stable angina].
abstract: OBJECTIVE
  To compare the efficiency and safety of antianginal therapy (AAT) using a combination of bisoprolol, ivabradine, and trimetazidine or ranolazine in elderly and senile patients with stable angina.
  
  
  METHODS
  The study enrolled 107 patients aged 60 to 79 years with coronary heart disease and Functional Class II and III angina. When the patients taking bisoprolol 1.25-2.5 mg once daily and ivabradine 2.5-7.5 mg twice daily continued to have angina and/or silent myocardial ischemia, after randomization 54 patients received an additional 35 mg of trimetazidine twice a day and 53 patients had ranolazine 500 mg twice daily. A comprehensive clinical and instrumental study was conducted prior to randomization and after 6 months of triple AAT.
  
  
  RESULTS
  The patients tolerated well both treatments that substantially improved the results of a treadmill exercise test. Trimetazidine reduced to a greater extent the duration of silent ST-segment depression, as evidenced by Holter monitoring. Trimetazidine and ranolazine comparably improved left ventricular systolic and diastolic function, large arterial structure and function, and quality of life in the patients.
  
  
  CONCLUSIONS
  The combinations of the low-dose β-blocker with ivabradine and trimetazidine or ranolazine may be used to treat refractory stable angina in elderly and senile patients. Trimetazidine is preferred due to its higher efficacy in treating silent myocardial ischemia and to its lower cost.
authors.affiliation: Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia.
authors.forename: S G
authors.initials: SG
authors.lastname: Kanorskii
authors.affiliation: Kuban State Medical University, Ministry of Health of Russia, Krasnodar, Russia.
authors.forename: N V
authors.initials: NV
authors.lastname: Smolenskaya
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001552:Benzazepines / Q000008:administration & dosage / Q000009:adverse effects; D017298:Bisoprolol / Q000008:administration & dosage / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects; D003327:Coronary Disease / Q000150:complications*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D000069458:Ranolazine / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014292:Trimetazidine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine; D000069458:Ranolazine; D014292:Trimetazidine; D017298:Bisoprolol