Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN)
The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative...
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| Veröffentlicht in: | Angiology 1999-06, Vol.50 (6), p.447 |
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| creator | van der Vring, J A Daniëls, M C Holwerda, N J Withagen, P J Schelling, A Cleophas, T J Hendriks, M G |
| description | The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depression on ETT (p |
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The Netherlands Working Group on Cardiovascular Research (WCN)</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><creator>van der Vring, J A ; Daniëls, M C ; Holwerda, N J ; Withagen, P J ; Schelling, A ; Cleophas, T J ; Hendriks, M G</creator><creatorcontrib>van der Vring, J A ; Daniëls, M C ; Holwerda, N J ; Withagen, P J ; Schelling, A ; Cleophas, T J ; Hendriks, M G</creatorcontrib><description><![CDATA[The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depression on ETT (p<0.001 for any treatment versus baseline). In addition, mibefradil, both low- and high-dose treatment, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, p<0.003 and <0.001, respectively; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, p<0.001 and <0.001, respectively). These effects were linearly correlated to the amount of rate pressure product (RPP) reduction. Serious symptoms of dizziness likewise occurred significantly more frequently with mibefradil (p<0.05) and led 19 patients taking mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with negative chronotropic property provide better delay of ischemia in patients with exercise-induced angina but that the concomitant risk of intolerable dizziness largely reduces this benefit.]]></description><identifier>ISSN: 0003-3197</identifier><identifier>PMID: 10378820</identifier><language>eng</language><publisher>United States</publisher><subject><![CDATA[Adolescent ; Adrenergic beta-Antagonists - administration & dosage ; Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aged ; Amlodipine - administration & dosage ; Amlodipine - adverse effects ; Amlodipine - therapeutic use ; Angina Pectoris - drug therapy ; Angina Pectoris - etiology ; Benzimidazoles - administration & dosage ; Benzimidazoles - adverse effects ; Benzimidazoles - therapeutic use ; Blood Pressure - drug effects ; Calcium Channel Blockers - administration & dosage ; Calcium Channel Blockers - adverse effects ; Calcium Channel Blockers - classification ; Calcium Channel Blockers - therapeutic use ; Diltiazem - administration & dosage ; Diltiazem - adverse effects ; Diltiazem - therapeutic use ; Dizziness - chemically induced ; Double-Blind Method ; Drug Combinations ; Electrocardiography - drug effects ; Exercise Test ; Female ; Heart Rate - drug effects ; Humans ; Male ; Mibefradil ; Middle Aged ; Myocardial Ischemia - prevention & control ; Physical Exertion - physiology ; Tetrahydronaphthalenes - administration & dosage ; Tetrahydronaphthalenes - adverse effects ; Tetrahydronaphthalenes - therapeutic use ; Time Factors]]></subject><ispartof>Angiology, 1999-06, Vol.50 (6), p.447</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10378820$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Vring, J A</creatorcontrib><creatorcontrib>Daniëls, M C</creatorcontrib><creatorcontrib>Holwerda, N J</creatorcontrib><creatorcontrib>Withagen, P J</creatorcontrib><creatorcontrib>Schelling, A</creatorcontrib><creatorcontrib>Cleophas, T J</creatorcontrib><creatorcontrib>Hendriks, M G</creatorcontrib><title>Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN)</title><title>Angiology</title><addtitle>Angiology</addtitle><description><![CDATA[The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depression on ETT (p<0.001 for any treatment versus baseline). In addition, mibefradil, both low- and high-dose treatment, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, p<0.003 and <0.001, respectively; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, p<0.001 and <0.001, respectively). These effects were linearly correlated to the amount of rate pressure product (RPP) reduction. Serious symptoms of dizziness likewise occurred significantly more frequently with mibefradil (p<0.05) and led 19 patients taking mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with negative chronotropic property provide better delay of ischemia in patients with exercise-induced angina but that the concomitant risk of intolerable dizziness largely reduces this benefit.]]></description><subject>Adolescent</subject><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Amlodipine - administration & dosage</subject><subject>Amlodipine - adverse effects</subject><subject>Amlodipine - therapeutic use</subject><subject>Angina Pectoris - drug therapy</subject><subject>Angina Pectoris - etiology</subject><subject>Benzimidazoles - administration & dosage</subject><subject>Benzimidazoles - adverse effects</subject><subject>Benzimidazoles - therapeutic use</subject><subject>Blood Pressure - drug effects</subject><subject>Calcium Channel Blockers - administration & dosage</subject><subject>Calcium Channel Blockers - adverse effects</subject><subject>Calcium Channel Blockers - classification</subject><subject>Calcium Channel Blockers - therapeutic use</subject><subject>Diltiazem - administration & dosage</subject><subject>Diltiazem - adverse effects</subject><subject>Diltiazem - therapeutic use</subject><subject>Dizziness - chemically induced</subject><subject>Double-Blind Method</subject><subject>Drug Combinations</subject><subject>Electrocardiography - drug effects</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart Rate - drug effects</subject><subject>Humans</subject><subject>Male</subject><subject>Mibefradil</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - prevention & control</subject><subject>Physical Exertion - physiology</subject><subject>Tetrahydronaphthalenes - administration & dosage</subject><subject>Tetrahydronaphthalenes - adverse effects</subject><subject>Tetrahydronaphthalenes - therapeutic use</subject><subject>Time Factors</subject><issn>0003-3197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtLw0AUhSMorVb_gtylLiKTTvOoOwlahVJBCl2Wm5k7zdhJJswkPv69g1XcubrcwzkfB85xdMoY4zFP5vk4OvP-NbxpwrJRNE4Yz4tiyk6PRqVtKt1ir20LVoFAI_TQgKixbclAZazYk_OArYSKevxTlHXQhSC1vYd33ddAH-SE9hTrVg6CZAjtAhs6Er112t8CgrRDZSiuTPCEuENjyMQ7Z4cOhG2Cov2hitRKkQt0EAa9J_9fvxtY1wQr6mtyJnT1sLFur9sdLL7RAVmik9q-oReDQQcv5AmdqOFqU66uz6MThcbTxc-dROuH-3X5GC-fF0_l3TLu0hmL0xkWTBYsS1WKjPMsqUipaZErLGRRSD6bZkxQPp9N0yxJ5qlKiJAJTsHMqpxPossDthuqhuS2c7pB97n9HYR_ARmwjBw</recordid><startdate>199906</startdate><enddate>199906</enddate><creator>van der Vring, J A</creator><creator>Daniëls, M C</creator><creator>Holwerda, N J</creator><creator>Withagen, P J</creator><creator>Schelling, A</creator><creator>Cleophas, T J</creator><creator>Hendriks, M G</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>199906</creationdate><title>Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN)</title><author>van der Vring, J A ; Daniëls, M C ; Holwerda, N J ; Withagen, P J ; Schelling, A ; Cleophas, T J ; Hendriks, M G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p540-54a80d8065f5a03361beff287fa8d88d34260ce7942561195f1eea0c3e0330b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Amlodipine - administration & dosage</topic><topic>Amlodipine - adverse effects</topic><topic>Amlodipine - therapeutic use</topic><topic>Angina Pectoris - drug therapy</topic><topic>Angina Pectoris - etiology</topic><topic>Benzimidazoles - administration & dosage</topic><topic>Benzimidazoles - adverse effects</topic><topic>Benzimidazoles - therapeutic use</topic><topic>Blood Pressure - drug effects</topic><topic>Calcium Channel Blockers - administration & dosage</topic><topic>Calcium Channel Blockers - adverse effects</topic><topic>Calcium Channel Blockers - classification</topic><topic>Calcium Channel Blockers - therapeutic use</topic><topic>Diltiazem - administration & dosage</topic><topic>Diltiazem - adverse effects</topic><topic>Diltiazem - therapeutic use</topic><topic>Dizziness - chemically induced</topic><topic>Double-Blind Method</topic><topic>Drug Combinations</topic><topic>Electrocardiography - drug effects</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart Rate - drug effects</topic><topic>Humans</topic><topic>Male</topic><topic>Mibefradil</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - prevention & control</topic><topic>Physical Exertion - physiology</topic><topic>Tetrahydronaphthalenes - administration & dosage</topic><topic>Tetrahydronaphthalenes - adverse effects</topic><topic>Tetrahydronaphthalenes - therapeutic use</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Vring, J A</creatorcontrib><creatorcontrib>Daniëls, M C</creatorcontrib><creatorcontrib>Holwerda, N J</creatorcontrib><creatorcontrib>Withagen, P J</creatorcontrib><creatorcontrib>Schelling, A</creatorcontrib><creatorcontrib>Cleophas, T J</creatorcontrib><creatorcontrib>Hendriks, M G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Angiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Vring, J A</au><au>Daniëls, M C</au><au>Holwerda, N J</au><au>Withagen, P J</au><au>Schelling, A</au><au>Cleophas, T J</au><au>Hendriks, M G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN)</atitle><jtitle>Angiology</jtitle><addtitle>Angiology</addtitle><date>1999-06</date><risdate>1999</risdate><volume>50</volume><issue>6</issue><spage>447</spage><pages>447-</pages><issn>0003-3197</issn><abstract><![CDATA[The combination of calcium channel blockers and beta blockers is more effective for the treatment of exercise-induced angina pectoris than beta blocker monotherapy. Since ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 and 10 mg, diltiazem XR 200 and 300 mg, and mibefradil 50 and 100 mg treatment added to baseline beta blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. Although none of the calcium channel blockers improved duration of exercise or amount of workload, all of them significantly delayed onset of 1 mm ST segment depression on ETT (p<0.001 for any treatment versus baseline). In addition, mibefradil, both low- and high-dose treatment, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 s, p<0.003 and <0.001, respectively; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 s, p<0.001 and <0.001, respectively). These effects were linearly correlated to the amount of rate pressure product (RPP) reduction. Serious symptoms of dizziness likewise occurred significantly more frequently with mibefradil (p<0.05) and led 19 patients taking mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with negative chronotropic property provide better delay of ischemia in patients with exercise-induced angina but that the concomitant risk of intolerable dizziness largely reduces this benefit.]]></abstract><cop>United States</cop><pmid>10378820</pmid></addata></record> |
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| ispartof | Angiology, 1999-06, Vol.50 (6), p.447 |
| issn | 0003-3197 |
| language | eng |
| recordid | cdi_pubmed_primary_10378820 |
| source | SAGE Complete A-Z List; MEDLINE |
| subjects | Adolescent Adrenergic beta-Antagonists - administration & dosage Adrenergic beta-Antagonists - therapeutic use Adult Aged Amlodipine - administration & dosage Amlodipine - adverse effects Amlodipine - therapeutic use Angina Pectoris - drug therapy Angina Pectoris - etiology Benzimidazoles - administration & dosage Benzimidazoles - adverse effects Benzimidazoles - therapeutic use Blood Pressure - drug effects Calcium Channel Blockers - administration & dosage Calcium Channel Blockers - adverse effects Calcium Channel Blockers - classification Calcium Channel Blockers - therapeutic use Diltiazem - administration & dosage Diltiazem - adverse effects Diltiazem - therapeutic use Dizziness - chemically induced Double-Blind Method Drug Combinations Electrocardiography - drug effects Exercise Test Female Heart Rate - drug effects Humans Male Mibefradil Middle Aged Myocardial Ischemia - prevention & control Physical Exertion - physiology Tetrahydronaphthalenes - administration & dosage Tetrahydronaphthalenes - adverse effects Tetrahydronaphthalenes - therapeutic use Time Factors |
| title | Combination of calcium channel blockers and beta blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. The Netherlands Working Group on Cardiovascular Research (WCN) |
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