Circulation, Vol 71, 1197-1205, Copyright © 1985 by American Heart Association
WE Boden, EW Bough, MJ Reichman, VB Rich, PM Young, KS Korr and RS Shulman
The effects of orally administered diltiazem combined with maximally
tolerated doses of beta-blockers and nitrates were assessed in 12 patients,
who during stress testing exhibited persistent effort angina and continued
objective evidence for inducible myocardial ischemia. Patients performed
multistage semisupine exercise on a bicycle ergometer during
equilibrium-gated radionuclide angiography after consecutive 2 week
treatment periods of placebo or diltiazem 90 mg qid (mean dose 340 mg/day)
combined with maximally tolerated propranolol (mean dose 178 mg/day) and
isosorbide dinitrate (mean dose 137 mg/day). All medications (including
diltiazem or placebo) were administered four times daily for the duration
of the study. Diltiazem or placebo was administered according to a
double-blind design, with randomized cross- over at the end of each 2 week
treatment period. The average number of angina attacks decreased during the
double-blind cross-over phase of the trial (7 +/- 7 episodes/week at
baseline vs 4 +/- 3 on placebo vs 2 +/- 2 on diltiazem; p = .08). Angina
pectoris was abolished during peak exercise in eight of 12 patients on
diltiazem (p less than .05 vs placebo). Diltiazem increased total exercise
duration from 276 +/- 92 to 310 +/- 78 sec (p less than .005 vs baseline).
Diltiazem likewise increased the time to onset of angina from 231 +/- 84
sec at baseline to 305 +/- 77 sec (p less than .005), as well as the time
to the onset of 1 mm ischemic ST segment depression (p = .01). Diltiazem
decreased heart rate at rest, during submaximal workload, and at peak
exercise (p less than .05), and decreased systolic blood pressure at peak
exercise only (p less than .05). A significant decline in rate-pressure
product at submaximal and peak exercise was noted (p less than .05). At any
given workload there was significantly less ST segment depression during
submaximal (p = .05) and peak exercise (p less than .025).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Beneficial effects of high-dose diltiazem in patients with persistent effort angina on beta-blockers and nitrates: a randomized, double- blind, placebo-controlled cross-over study
This article has been cited by other articles:
 |
|
 |
|
  J. A. Cairns Ranolazine: Augmenting the Antianginal Armamentarium J. Am. Coll. Cardiol., August 1, 2006; 48(3): 576 - 578. [Full Text] [PDF]
|
|
|
|
 |
|
 B. R. Chaitman Ranolazine as Add-on Therapy for Patients With Severe Chronic Angina--Reply JAMA, April 28, 2004; 291(16): 1959 - 1960. [Full Text] [PDF]
|
|
|
|
|
|
B. R. Chaitman, C. J. Pepine, J. O. Parker, J. Skopal, G. Chumakova, J. Kuch, W. Wang, S. L. Skettino, and A. A. Wolff Effects of Ranolazine With Atenolol, Amlodipine, or Diltiazem on Exercise Tolerance and Angina Frequency in Patients With Severe Chronic Angina: A Randomized Controlled Trial JAMA, January 21, 2004; 291(3): 309 - 316. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Shimoyama, H. N. Sabbah, M. Tanimura, S. Borzak, and S. Goldstein Short-Term Hemodynamic Effects of Mibefradil in Dogs With Chronic Heart Failure: Comparison With Diltiazem J. Pharmacol. Exp. Ther., May 1, 1998; 285(2): 746 - 752. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. D. Parker and J. O. Parker Nitrate Therapy for Stable Angina Pectoris N. Engl. J. Med., February 19, 1998; 338(8): 520 - 531. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Merino, E. Alegria, R. Castello, M. Fidalgo, A. Abecia, and D. Martinez-Caro Complementary Mechanisms of Atenolol and Diltiazem in the Clinical Improvement of Patients with Stable Angina Angiology, July 1, 1989; 40(7): 626 - 632. [Abstract] [PDF]
|
|