Effect of Nisoldipine on Myocardial Ischemia: Evaluation by Holter Monitoring
The effect of nisoldipine on myocardial ischemia during daily activity was studied in ten patients with chronic ischemic heart disease. There were nine males and one female, and their ages ranged from 50–76 years, mean of 63 years. All patients had a positive treadmill stress test, with and without angina pectoris, and had at least three ischemic episodes on a preliminary 24-h Holter monitoring.
Every patient performed 72-h Holter monitoring as a baseline study and a Bruce protocol exercise test at the end of these days of baseline monitoring. Nisoldipine therapy was then given (10 mg twice daily) for 3 days, after which the patients had another 3 days of Holter monitoring, and another exercise test was also performed.
During the control period 229 ischemic episodes were recorded in the ten patients, with variation between patients: 15–31 ischemic episodes per 72 h. The mean number of ischemic episodes per patient was 22.9.
The total duration of ischemia in the ten patients was 2918 min, with a wide range between patients (137–561 min). The mean ischemic duration per patient was 291.8 min.
During nisoldipine therapy the total number of ischemic episodes was reduced to 157 (P < 0.008), and the mean number of ischemic episodes per patient was reduced to 15.7. The total duration of ischemia was reduced to 1533 min (P < 0.006), and the mean duration of ischemia was reduced to 153.3 min. In nine patients both the number and the total duration of ischemia were markedly reduced. In one patient there was a slight increase in the number of ischemic episodes from 20 to 22 and in the duration of ischemia from 137 to 198 min. Of the 229 ischemic episodes observed during the control period, 194 (85%) were silent and 34 (15%) were symptomatic. There was a similar reduction in the number of silent and symptomatic episodes during nisoldipine therapy.
No significant changes were noted in all exercise parameters during the control period and during treatment with nisoldipine.
The preliminary results suggest that nisoldipine has a beneficial effect on spontaneous ischemic episodes occurring during daily activity.
KeywordsMyocardial Ischemia Holter Monitoring Ischemic Episode Chronic Ischemic Heart Disease Antianginal Therapy
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