Effects of propranolol and isosorbide dinitrate on exercise performance and adrenergic acitivity in patients with angina pectoris

Twelve patients with angina pectoris were evaluated in a single blind crossover study with respect to objective changes in exercise performance on the treadmill and subjective, clinical improvement on oral administration of propranolol, isosorbide dinitrate (ISD), and a combination of propranolol and ISD. Combined objective and subjective evaluations showed that nine of 12 patients improved on propranolol, seven of 10 on ISD, and all 10 on the combination of drugs. The differences in objective improvement between the various drug regimens were not significant. However, subjectively all patients on the combination of drugs improved markedly. The patients on propranolol or the combination had a decrease in pressure-rate index of about 30% both at rest and during exercise, while these values did not change on ISD. A significant reduction in exercise-induced S-T depression was observed with propranolol alone and in combination with ISD at grade 3+ pain. Adrenergic activity, estimated from plasma and urinary catecholamines, appeared to be increased in these patients before drug treatment and was not altered during treatment. It is concluded that propranolol, ISD, and the combination of these drugs all improve exercise performance in patients with angina. Although the combination of drugs could not be shown to produce a greater increase in exercise performance than either drug alone, the combination effected a greater overall clinical improvement.