Calcium antagonist treatment and its effects on left ventricular function in patients with ischaemic heart disease

Therapy for angina pectoris: comparison of nicardipine with other antianginal agents

Nicardipine is a new dihydropyridine calcium channel blocking drug with actions that suggest considerable usefulness as an agent for chronic stable angina. Hemodynamic studies in patients with coronary artery disease confirm major coronary vasodilator actions, perhaps even exceeding its considerable systemic vasodilator properties with little or no negative inotropic effect. Three recent controlled clinical trials that used nicardipine alone suggest approximately 20% to 30% increase in exercise time, and at least that much decrease in anginal episodes and sublingual nitroglycerin consumption when compared with placebo in doses of 90 to 120 mg daily. Five trials comparing nicardipine with other calcium channel blockers, and three with beta blockers, suggest equivalent efficacy, including decrease in angina and increase in exercise time. Adverse effects of nicardipine generally relate to its potent vasodilatory capability and are usually minor. Side effects are frequent at the beginning of many trials, usually do not cause undue withdrawals, and are quite rare after 6 to 12 months on the drug in most studies.

Comparison of nicardipine and verapamil in the management of chronic stable angina

Twenty-two patients with stable angina were studied in a randomised double-blind, placebo-controlled crossover trial to compare the antianginal effects of nicardipine (30 mg) and verapamil (120 mg), each given three times a day. Efficacy was assessed using treadmill exercise testing and 24-hour ambulatory electrocardiographic monitoring performed after an initial 2-week placebo phase and at the end of each 4-week active treatment period. Exercise time (mean +/- standard error of mean) increased from 7.4 +/- 0.5 min on placebo to 8.4 +/- 0.7 min on nicardipine (P less than 0.05) and to 9.9 +/- 0.7 min on verapamil (P less than 0.001). Resting heart rate was decreased by verapamil (P less than 0.002) and increased by nicardipine (P less than 0.02). Exercise heart rate was increased on nicardipine (P less than 0.005) but heart rate gain was higher on verapamil (P less than 0.01). Blood pressure and peak ST segment depression were unaltered by either drug but the time to 1 mm ST segment depression increased on both drugs. Ambulatory heart rates were lower on verapamil than on nicardipine and patient subjective preference was in favour of verapamil. This study confirms that both nicardipine and verapamil improve exercise capacity, but verapamil produces a greater improvement in exercise tolerance and indices of myocardial ischaemia whilst nicardipine is associated with an increase in the number of episodes of ST segment depression on ambulatory monitoring.