Circulation, Vol 69, 728-739, Copyright © 1984 by American Heart Association
JE Muller, ZG Turi, DL Pearle, JF Schneider, DH Serfas, J Morrison, PH Stone, RE Rude, B Rosner and BE Sobel
To characterize the potential of nifedipine in the therapy of unstable
angina pectoris we implemented a blinded, randomly assigned, titrated
schedule of conventional therapy (propranolol, if not contraindicated, and
isosorbide dinitrate) or nifedipine for 14 days in 126 patients
hospitalized in a coronary care unit for ischemic chest pain of less than
45 min duration. There were no significant differences between
conventionally and nifedipine-treated patients with regard to (1) the time
to relief of pain as judged by life table analysis, (2) the decrease in
anginal attacks per 24 hr from day 0 to day 2 (-2.5 +/- 0.4 for
conventional therapy vs; -2.8 +/- 0.3 for nifedipine), (3) the decrease in
the number of nitroglycerin tablets consumed per 24 hr (- 2.0 +/- 0.5 for
conventional vs -2.1 +/- 0.4 for nifedipine therapy), (4) the percentage of
patients requiring morphine on day 1 (13% for conventional vs 21% for
nifedipine therapy), or (5) the percentage of patients who developed
infarction (14% in both groups). Among the 27 patients who did not respond
to initial conventional (n = 13) or nifedipine therapy (n = 14), five in
each group became pain free when the opposite therapy (either nifedipine or
conventional therapy) was added. In the subgroup of 67 patients who were
receiving propranolol before randomization, addition of nifedipine was more
effective in controlling pain than was an increase in conventional therapy
(p = .026). In the subgroup of 59 patients not receiving prior propranolol,
initiation of conventional therapy produced more rapid pain relief than
initiation of nifedipine therapy alone (p less than .001), which tended to
increase heart rate. Thus, for the study population as a whole therapy with
nifedipine alone was equivalent to conventional therapy for unstable
angina, although this overall equivalence may result from a combination of
superiority of nifedipine therapy in patients previously receiving
beta-blocker therapy and superiority of beta- blocker therapy in patients
not previously receiving beta-blockers.
ARTICLES
Nifedipine and conventional therapy for unstable angina pectoris: a randomized, double-blind comparison
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