Open AccessEfficacy of diltiazem for medically refractory stable angina: Long‐Term follow‐up
Author(s) -
Schroeder J. S.,
BeierScott L.,
Ginsburg R.,
Bristow M. R.,
Mcauley B. J.
Publication year - 1985
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960080905
Subject(s) - medicine , diltiazem , angina , atrial fibrillation , adverse effect , chest pain , refractory (planetary science) , myocardial infarction , discontinuation , surgery , anesthesia , cardiology , physics , astrobiology , calcium
To assess the efficacy of long‐term diltiazem therapy when added to beta blockers and nitrates, we prospectively studied patients with chronic exertional angina who were determined to have medically refractory angina pectoris which was too severe to enter placebocontrolled studies. The mean follow‐up time was 24.6 months (8‐47 months) and all patients were seen every 2‐4 months. Angina frequency decreased from a prediltiazem frequency of 9.5 episodes per week (1‐40 per week) to 3.3 attacks per week (0‐21 per week) at 6 months and 3.3 attacks per week (0‐40 per week) at the patients's last evaluation. Similar reductions in nitroglycerin consumption were reported. Five patients had an increase in angina frequency during the mean 24.6 months of follow‐up, which necessitated coronary bypass surgery, 8, 10, 12, 19, and 23 months after study entry, respectively. Diltiazem daily dosage ranged from 120 to 480 mg/day, the mean daily dose was 298 mg/day. Twenty (65%) patients remained on beta‐blocker therapy and 19 (61%) patients on nitrate therapy in an effort to achieve a completely painfree state. New cardiovascular events were documented in 3 patients during the follow‐up period, with one patient having an uncomplicated myocardial infarction at 6 months, one patient hospitalized for prolonged chest pain at 2 months, and one patient dying following cardiover‐sion for unrelated atrial fibrillation at 14 months poststudy entry. Adverse effects were reported during 19 of the 354 patient visits, but no patient had to stop therapy because of these. Sinus bradycardia required reduction of betablocker dosage in three patients and prolonged PR inteval was observed in two additional patients. Five patients exhibited mild transient, and three patients chronic elevations in liver enzymes. We conclude that the addition of diltiazem in patients who have severe angina on combinations of beta blockers and nitrates results in a marked reduction in angina frequency. Furthermore, this agent is well tolerated with minimal adverse effects.