Efficacy of once daily penbutolol in chronic stable angina. An objective comparison with long-acting propranolol

Usefulness of bevantolol for chronic, stable angina pectoris

An objective assessment of the efficacy of bevantolol was performed in 21 patients with chronic, stable angina using computer-assisted exercise testing and ambulatory ST-segment monitoring. Given once daily, 200 mg of bevantolol was compared with 200 mg of bevantolol given twice daily and with placebo, using a double-blind crossover technique. The mean exercise time with placebo was 7.4 +/- 0.6 minutes; this increased to 10.6 +/- 0.9 minutes (p less than 0.001) with once-daily bevantolol and to 9.4 +/- 0.9 minutes (p less than 0.001) with twice-daily bevantolol. The mean heart rate at rest was 80 +/- 3 beats/min with placebo; it decreased to 63 +/- 2 beats/min (p less than 0.001) with once-daily bevantolol and to 66 +/- 2 beats/min (p less than 0.001) with twice-daily bevantolol. The maximum exercise heart rate of 118 +/- 6 beats/min with placebo was reduced to 99 +/- 4 beats/min (p less than 0.001) on once-daily and 101 +/- 4 beats/min (p less than 0.001) on twice-daily bevantolol. There was a corresponding decrease in the rate-pressure product. The corrected maximum ST-segment depression was reduced from 0.3 +/- 0.06 mm min-1 with placebo to 0.2 +/- 0.03 mm min-1 (p less than 0.02) with once-daily and 0.2 +/- 0.04 mm min-1 (p less than 0.05) with twice-daily bevantolol. The mean hourly ambulatory heart rate was significantly reduced for 21 hours with once-daily and 22 hours with twice-daily bevantolol. The lowest mean minimum heart rate was 55 beats/min during twice-daily treatment. The mean number of episodes of ST depression over 24 hours in lead CM5 was decreased from 6.89 +/- 1.7 with placebo to 2.50 +/- 0.6 (p less than 0.001) with once-daily and to 3.72 +/- 1.3 (p less than 0.001) with twice-daily bevantolol. Three patients were withdrawn during the once-daily bevantolol regimen due to adverse experiences, and another patient was admitted for coronary artery bypass surgery after 25 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of propranolol on indices of intermittent myocardial ischemia, assessed by exercise testing and ambulatory ST-segment monitoring

Seventy three patients (63 males and 10 females) aged 41-75 years with established stable exertional angina pectoris were studied in a double-blind fashion to confirm the efficacy of 80 mg propranolol administered three times daily and also to examine its effect on ST-segment changes in the electrocardiogram by ambulatory ST-segment monitoring and exercise testing using on-line computer analysis. During ambulatory monitoring, episodes of ST-segment depression in lead CM5 were significantly reduced from 6.5 +/- 0.7 during placebo to 3.4 +/- 0.6 during propranolol therapy (p less than 0.001). The total duration of ST-segment depression was also significantly reduced and the maximal depth of ST-segment depression improved from 2.6 +/- 0.2 mm during placebo to 1.7 +/- 0.2 mm during propranolol therapy (p less than 0.001). The mean +/- SEM exercise time of 5.5 +/- 0.2 minutes on placebo increased to 8.6 +/- 0.4 minutes on propranolol 240 mg daily (p less than 0.001). The 1 mm ST-segment depression time of 3.5 +/- 0.2 minutes on placebo in lead CM5 was prolonged to 6.2 +/- 0.3 minutes during propranolol therapy (p less than 0.001). Propranolol treatment significantly reduced the resting and maximal heart rates (p less than 0.001). The maximal ST-segment depression during exercise in lead CM5 was reduced from 2.3 +/- 0.1 mm on placebo to 1.9 +/- 0.1 mm with propranolol (p less than 0.01). Similarly, the rate-pressure product at peak exercise of 188 +/- 5 units on placebo was reduced to 144 +/- 3 units with propranolol (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Short- and long-term efficacy of nicardipine, assessed by placebo-controlled single- and double-blind crossover trials in patients with chronic stable angina

The efficacy of nicardipine, a new calcium ion antagonist, was studied in 39 patients aged 42 to 70 years with chronic stable angina in two different placebo-controlled single- and double-blind crossover trials and with long-term follow-up, using serial quantitated exercise testing and ambulatory ST segment monitoring. In the first study the minimal effective dose was determined, and in the repeat study the effects of three different dose levels were evaluated. Treadmill exercise testing was performed at the end of each 2 week treatment period with on-line computer analysis of the electrocardiogram. The mean (+/- standard error of the mean) exercise time was 6.8 +/- 0.7 minutes on placebo and 7.0 +/- 0.8 minutes during treatment with nicardipine, 60 mg/day (p = NS). This increased to 8.7 +/- 0.8 (p less than 0.001) and 9.2 +/- 0.9 minutes (p less than 0.001) with 90 and 120 mg/day, respectively. The mean heart rate at rest during placebo administration was 75 +/- 2 beats/min and increased to 85 +/- 3, 84 +/- 2 and 88 +/- 3 beats/min (p less than 0.02, p less than 0.01, p less than 0.01, respectively) at each dose level. The time taken to develop 1 mm of ST segment depression was prolonged from 4.8 +/- 0.6 minutes during placebo administration to 5.3 +/- 0.7 (p = NS), 6.4 +/- 0.7 (p less than 0.01) and 6.7 +/- 0.8 minutes (p less than 0.001), respectively, at each dose level. The improvement achieved after 2 weeks of nicardipine, 120 mg daily, was maintained over a period of 6 months of follow-up. Three patients were withdrawn, one taking 60 mg of nicardipine, one taking 90 mg of nicardipine and one taking placebo, but the overall incidence of side effects was low. Nicardipine is an effective antianginal agent with an optimal dose of 90 to 120 mg/day.

Long-term efficacy of diltiazem assessed with multistage graded exercise tests in patients with chronic stable angina pectoris

The long-term efficacy of diltiazem, 360 mg/day, in patients with grade II or III stable exertional angina pectoris (Canadian Cardiovascular Society criteria) was assessed by multistage graded exercise tests. Seventeen patients undertook a placebo-controlled, double-blind, dose-titration protocol and all received long-term therapy. Exercise tests were performed at the end of 2 weeks of placebo treatment and after 6, 18, 26, 40 and 52 weeks of diltiazem, 360 mg/day. All patients had angina during treadmill testing with placebo and the mean (+/- standard error of the mean) exercise time was 5.8 +/- 0.7 minutes. This increased to 10.8 +/- 1.0 minutes after 6 weeks, 11.3 +/- 1.1 minutes after 18 weeks, 11.4 +/- 1.1 minutes after 26 weeks, 12.9 +/- 1.2 minutes after 40 weeks and 11.6 +/- 1.3 minutes after 52 weeks of continuous diltiazem therapy (p less than 0.001 vs placebo at all stages). Four patients were withdrawn after 26 weeks of treatment; one patient underwent coronary artery bypass surgery and 3 patients required the addition of beta-adrenoreceptor blocking agents. In 1 patient an irritant rash developed on the torso, legs and arms after 39 weeks of diltiazem and disappeared after discontinuing the drug. One patient complained of swelling and stiffness of the fingers and 3 patients complained of shoulder and elbow pain. Another patient had a myocardial infarction after 8 weeks of diltiazem treatment and died. No other adverse effects were observed during this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Reproducibility of multistage graded exercise testing in patients with chronic stable angina

Exercise testing is widely used for the diagnosis of ischaemic heart disease and for the evaluation of antianginal drugs. To assess reproducibility, analysis was carried out on 128 paired graded exercise tests from 103 patients performed at the same time of day and under identical conditions. Six different parameters were evaluated and compared between the basal test (no treatment) and the placebo test. During the basal period the mean (+/- SEM) exercise time to the development of angina was 6.0 (+/- 0.2) min and the 1 mm ST depression time was 4.1 (+/- 0.2) min. After 2 weeks of placebo the exercise time was 6.1 (+/- 0.2) min (P = NS) and the 1 mm ST depression time was 4.2 (+/- 0.2) min (P = NS). There was no significant difference between the resting or maximum heart rate on either test and the maximum ST segment depression (leads CM5 and CC5) was unaltered. In a second group of 17 patients where the basal tests were performed in the afternoon and the placebo tests in the morning, heart rate and ST segment were found to be reproducible but there was a significant difference in exercise time: 5.7 (+/- 0.7) min for the basal test and 8.3 (+/- 0.5) min for the placebo test (P less than 0.001); and of the 1 mm ST depression time: 2.7 (+/- 0.4) min for the basal test, and 5.4 (+/- 0.5) min for the placebo test (P less than 0.001). We conclude that exercise tests done under standardised conditions in the morning are highly reproducible in patients with chronic stable angina and therefore provide a valuable test for the evaluation of antianginal drugs.