Advertisement

Antianginal Effects of Calcium Antagonists

  • John S. Schroeder
Chapter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 39)

Abstract

The potent relaxation of vascular smooth muscle which occurs upon introduction of a calcium antagonist into either a muscle bath or when administered to a patient provides the basis for their increasing use in patients disabled by angina pectoris due to either occlusive coronary artery disease or coronary artery spasm. As discussed elsewhere in this symposium, the relative selectivity of calcium blockers for vascular smooth muscle over cardiac muscle, allows their use in therapeutic ranges with minimal negative inotropic effects. In the late 1970’s, case reports in uncontrolled studies began reporting the efficacy of calcium blockers for the treatment of coronary artery spasm.(1–5) Subsequently, it was found that these agents could be highly effective in patients with typical exertional angina as well. This paper will review the clinical applications of the calcium blockers in patients with either coronary artery spasm or exertional angina due to occlusive coronary artery disease.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Muller JE, Gunther SJ: Nifedipine therapy for Prinzmetal’s angina. Circulation (57): 137–139, 1978.PubMedCrossRefGoogle Scholar
  2. 2.
    Gunther S, Green L, Muller JE, Mudge GH Jr, Grossman W: Inappropriate coronary vasoconstriction in patients with coronary artery disease: a role for nifedipine? Am J Cardiol (44): 793–801, 1979.PubMedCrossRefGoogle Scholar
  3. 3.
    Heupler FA Jr, Proudfit WL: Nifedipine therapy for refractory arterial spasm. Am J Cardiol (44): 798–805, 1979.PubMedCrossRefGoogle Scholar
  4. 4.
    Yasue H, Omote S, Takizawa A, Nagao M, Miwa K, Tanaka S: Exertional angina pectoris caused by coronary arterial spasm: effects of various drugs. Am J Cardiol (43): 647–651, 1979.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenthal SJ, Ginsburg R, Lamb IH, Baim DS, Schroeder JS: Efficacy of diltiazem for control of symptoms of coronary arterial spasm. Am J Cardiol (46): 1027–1031, 1980.PubMedCrossRefGoogle Scholar
  6. 6.
    Prinzmetal M, Kennamer R, Merliss R, Wada T, Bor N: Angina pectoris. I. A variant form of angina pectoris: preliminary report. Am J Med (27): 375–388, 1959.PubMedCrossRefGoogle Scholar
  7. 7.
    Hart NJ, Silverman ME, King SB: Variant angina pectoris caused by coronary artery spasm. Am J Med (56): 269–274.Google Scholar
  8. 8.
    Schroeder JS, Rosenthal S, Ginsburg R, Lamb IH: Medical therapy of Prinzmetal’s variant angina. Chest (78): 231–233, 1980.PubMedCrossRefGoogle Scholar
  9. 9.
    Rosenthal SJ, Ginsburg R, Lamb IH, Baim DS, Schroeder JS: Efficacy of diltiazem for control of symptoms of coronary arterial spasm. Am J Cardiol (46): 1027–1032, 1980.PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenthal SJ, Lamb IH, Schroeder JS, Ginsburg R: Long-term efficacy of diltiazem for control of symptoms of coronary artery spasm. Circulation Research/Suppl. I, Calcium Channel-Blocking Drugs (52): I-153–I157, 1983.Google Scholar
  11. 11.
    Antman E, Muller JE, Goldberg S, MacAlpin R, Rubenfire M, Tabatznik B, Liang C, Heupler F, Achuff S, Reichek N, Geltman E, Kerin NZ, Neff RK, Braunwald E: Nifedipine therapy for coronary-artery spasm: experience in 127 patients. N Engl J Med (302): 1269–1273, 1980.PubMedCrossRefGoogle Scholar
  12. 12.
    Hill JA, Feldman RL, Conti R, Hill CK, Pepine CJ: Long-term responses to nifedipine in patients with coronary spasm who have an initial favorable response. Am J Cardiol (52): 26–29, 1983.PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson SM, Mauritson DR, Willerson JT, Hillis LD: A controlled trial of verapamil for Prinzmetal’s variant angina. N Engl J Med (304): 862–866, 1981.PubMedCrossRefGoogle Scholar
  14. 14.
    Johnson SM, Mauritson DR, Willerson JT, Cary JR, Hillis LD: Verapamil administration in variant angina pectoris. JAMA (245): 1849–1851, 1981.PubMedCrossRefGoogle Scholar
  15. 15.
    Johnson SM, Mauritson DR, Willerson JT, Hillis LD: Comparison of verapamil and nifedipine in the treatment of variant angina pectoris: preliminary observations in 10 patients. Am J Cardiol (47): 1295–1300, 1981.PubMedCrossRefGoogle Scholar
  16. 16.
    Rich S, Ford LE, Al-Sadir J: The angiographic effect of ergonovine and nifedipine in coronary artery spasm. Circulation (62): 1127–1130, 1980.PubMedCrossRefGoogle Scholar
  17. 17.
    Tiefenbrunn AJ, Sobel BE, Gowda S, McKnight RC, Ludbrook PA: Nifedipine blockade of ergonovine-induced coronary arterial spasm: angiographic documentation. Am J Cardiol (48): 184–187, 1981.PubMedCrossRefGoogle Scholar
  18. 18.
    Hung J, Lamb IH, Connolly SJ, Jutzy KR, Goris ML, Schroeder JS: The effect of diltiazem and propranolol, alone and in combination, on exercise performance and left ventricular function in patients with stable effort angina: a double-blind, randomized, and placebo-controlled study. Circulation (68): 560–567, 1973.CrossRefGoogle Scholar
  19. 19.
    Hossack KF, Bruce RA: Improved exercise performance in persons with stable angina pectoris receiving diltiazem. Am J Cardiol (47): 95–101, 1981.PubMedCrossRefGoogle Scholar
  20. 20.
    Hossack KF, Pool PE, Steele P, Crawford MH, DeMaria AN, Cohen LS, Ports TA: Efficacy of diltiazem in angina on effort: a multicenter trial. Am J Cardiol (49): 567–572, 1982.PubMedCrossRefGoogle Scholar
  21. 21.
    Hossack KF, Bruce RA, Ritterman JB, Kusumi F, Trimble S: Divergent effects of diltiazem in patients with exertional angina. Am J Cardiol (49): 538–546, 1982.PubMedCrossRefGoogle Scholar
  22. 22.
    Mueller HS, Chahine RA: Interim report of multicenter double-blind, placebo- controlled studies of nifedipine in chronic stable angina. Am J Med (71): 645–657, 1981.PubMedCrossRefGoogle Scholar
  23. 23.
    Moskowitz RM, Piccini PA, Nacarelli GV, et al: Nifedipine therapy for stable angina pectoris: Preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol (44): 811–816, 1979.PubMedCrossRefGoogle Scholar
  24. 24.
    Kenmure ACF, Scruton JH: A double-blind controlled trial of the antianginal efficacy of nifedipine compared with propranolol, in Jatene AD, Lichtlen PR, (eds): Third International Adalat Symposium. Excerpta Medica, Amsterdam, 1976, pp 268–271.Google Scholar
  25. 25.
    Lynch P, Dargie H, Krikler S, et al: Objective assessment of antianginal treatment: A double-blind comparison of propranolol, nifedipine, and their combination. Br Med J (281): 184–187, 1980.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Pine MB, Citron PD, Bailly DJ, et al: Verapamil versus placebo in relieving stable angina pectoris. Circulation (65): 17–22, 1982.PubMedCrossRefGoogle Scholar
  27. 27.
    Subramanian VB, Lahiri A, Paramasivan R, et al: Verapamil in chronic stable angina. Lancet (1): 841–844, 1980.PubMedCrossRefGoogle Scholar
  28. 28.
    Subramanian VB, Bowles M, Lahira A, et al: Long-term antianginal action of verapamil assessed with quantitated serial treadmill stress testing. Am J Cardiol (48): 529–535, 1981.PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson SM, Mauritson DR, Corbett JR, et al: Double-blind, randomized, placebo-controlled comparison of propranolol and verapamil in the treatment of patients with stable angina pectoris. Am J Med (71): 443–451, 1981.PubMedCrossRefGoogle Scholar
  30. 30.
    Frishman WH, Klein NA, Strom JA, et al: Superiority of verapamil to propranolol in stable angina pectoris: A double-blind, randomized crossover trial. Circulation (65) (Suppl. 1): 51–59, 1982.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston 1984

Authors and Affiliations

  • John S. Schroeder

There are no affiliations available

Personalised recommendations