Khurmi NS, Raftery EB. Comparative effects of prolonged therapy with four calcium ion antagonists (diltiazem, nicardipine, tiapamil and verapamil) in patients with chronic stable angina pectoris.
Cardiovasc Drugs Ther 1987;
1:81-7. [PMID:
3154312 DOI:
10.1007/bf02125837]
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Abstract
The comparative effects of prolonged chronic therapy with diltiazem, nicardipine, tiapamil and verapamil on exercise tolerance, ST-segment changes and heart rate were examined in 63 patients with established chronic stable angina pectoris. Multistage computer-assisted symptom-limited treadmill exercise tests were performed after 2 weeks of placebo ("baseline") and then after 4 months of open-label chronic drug therapy. Diltiazem improved the exercise duration by 95% (p less than 0.001), nicardipine by 45% (p less than 0.001), tiapamil by 69% and verapamil by 79% (p less than 0.001). Maximal ST-segment depression was not altered by any of the drugs, but time to the development of 1 mm ST-segment depression was significantly improved in all cases. Diltiazem and verapamil reduced the heart rate at rest significantly by 6 and 8 beats/minute, respectively, whereas nicardipine increased it by 10 beats/minute (p less than 0.02), and tiapamil did not produce any significant change. Maximal heart rate at the peak of exercise was increased by 14% with nicardipine (p less than 0.001) and 6% with verapamil (p less than 0.05), whereas diltiazem and tiapamil did not produce any appreciable effect. The rate-pressure product at the peak of exercise remained unaltered with diltiazem, tiapamil and verapamil, but with nicardipine it increased significantly to 222 +/- 10 units from a baseline of 175 +/- 6 units with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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