Efficacy of Nisoldipine Compared with Nifedipine in Chronic Stable Angina Pectoris
The antianginal effects of the new calcium entry blocker nisoldipine were evaluated and compared with those of nifedipine in a double-blind study of two similar groups of 15 randomly allocated patients. Clinical assessment as well as submaximal ergometric exercise were performed before and after 4 and 8 weeks of continuing therapy with 10 mg nisoldipine daily or 10 mg nifedipine three times daily.
In a single patient study medication nisoldipine was discontinued due to the occurrence of marked tachycardia and increased incidence of chest pains. Other mild side effects occurred in three patients but did not necessitate discontinuation of the study.
The number of anginal attacks decreased from 5.5 to 1. 8 per week in the nisoldipine group and from 6.7 to 1.1 in the nifedipine group. The requirement for sublingual nitrates decreased accordingly. Exercise tolerance was significantly improved. Maximal workload (mean ± SE) increased during therapy from 67.0 ± 3.1 to 73.2 ± 4.0W (nisoldipine) and from 58.3 ± 6.5 to 65.0 ± 7.0 W (nifedipine).
Time to occurrence of chest pains during exercise increased from 9.0 ± 1.1 to 9. 75 ± 1.2 min and from 5.5 ± 0.5 to 7.5 ± 0.9 min (nifedipine).
At the last ergometry measurement during therapy, 4 of 14 patients on nisoldipine experienced chest pains on maximal exertion as compared with 6 on nifedipine.
Marked improvement was achieved in the ischemic ST depression at maximal exercise, as expressed in percent of baseline value, under both regimens. On nisoldipine therapy ST depression declined to 43.1% ± 9. 7% of baseline levels at the last ergometry reading. At the end nifedipine therapy the corresponding figure was 62.0% ± 15.2%. Time to occurrence of ST-segment depression was prolonged from 7.7 ± 0.8 to 8.6 ± 0.9 min (nisoldipine) and from 5.2 ± 0.7 to 6.4 ± 0.8 min (nifedipine).
Heart rate and blood pressure results during therapy were comparable in both groups. None of the trends over time were significantly different between the groups.
In conclusion appears that nisoldipine in the dosage used is at least as effective and well tolerated as nifedipine in its capacity as an antianginal agent.
KeywordsCalcium Antagonist Maximal Exercise Chronic Stable Angina Anginal Attack Sublingual Nitroglycerin
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