The purpose of this double-blind placebo-controlled crossover study was to assess the antianginal efficacy of oral amlodipine (10mg once daily) in 16 patients with stable effort angina.
After each 7-day treatment period, patients underwent symptom-limited exercise tests with electrocardiographic and 2D-echocardiographic assessment. Under resting conditions, systolic arterial pressure was significantly lower after treatment with amlodipine compared with placebo (126.5 vs 132.8mm Hg). Heart rate and the pressure-rate product did not differ appreciably between amlodipine and placebo treatment. The stress test results showed an increase in effort tolerance during amlodipine treatment compared with placebo (time to onset of angina = 6.8 vs 5.7 min), with a negative test in 25% of patients (4 of 16).
These favourable effects may be attributed to a reduction in myocardial oxygen consumption, as indicated by a slower increase in systolic blood pressure during exercise and the delayed occurrence of ischaemia during amlodipine therapy (time to ST-segment depression of 1mm = 4.5 vs 3.5 minutes). Moreover, the fact that patients with negative tests during amlodipine were able to work above their ischaemic threshold during placebo, suggests a possible increase in myocardial blood flow with amlodipine. In conclusion, amlodipine is effective in the treatment of stable angina pectoris. This drug reduces myocardial oxygen consumption and, in some patients, may also increase myocardial blood flow.
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