Open AccessParadoxical effect of long‐term treatment of nifedipine on total ischemic load in patients with stable angina pectoris
Author(s) -
Radice Maria,
Giudici Vittorio,
Albertini Alberto,
Mannarini Alberto
Publication year - 1992
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.4960150209
Subject(s) - medicine , nifedipine , metoprolol , diltiazem , angina , cardiology , ambulatory , stable angina , heart rate , vasodilation , hemodynamics , st depression , anesthesia , ischemia , blood pressure , coronary heart disease , myocardial infarction , calcium
In 50 patients with stable effort angina the effect of three drugs, metoprolol, nifedipine, and diltiazem was assessed by analyzing exercise stress test response and ambulatory ECG recordings. Both metoprolol and diltiazem caused a significant increase in time to ischemic threshold during exercise and a significant decrease of maximum ST‐segment depression (during exercise and ambulatory ECG monitoring) and in the average number of daily ischemic episodes. Only metoprolol significantly reduced heart rate and rate–pressure product at the ischemic threshold during exercise. In the group of patients treated with nifedipine no significant improvement was observed in exercise tolerance or in number of ischemic episodes/24 h. Moreover, the subset of nonresponders in the two methods was larger than in the other two groups. In some of these patients a clearcut worsening of total ischemic load was observed, despite the control of symptoms. This adverse effect might be attributed to the different consequences of the vasodilatory effect of nifedipine on blood flow through stenosed vessels.