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Efficacy of beta adrenergic blockade in coronary heart disease: Propranolol in angina pectoris
Author(s) -
Miller Richard R.,
Olson Harold G.,
Pratt Craig M.,
Amsterdam Ezra A.,
Mason Dean T.
Publication year - 1975
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt1975185part1598
Subject(s) - medicine , propranolol , angina , placebo , st depression , cardiology , blockade , anesthesia , heart rate , chest pain , crossover study , myocardial infarction , blood pressure , alternative medicine , receptor , pathology
Despite widespread clinical application of propranolol (P) in angina pectoris, convincing evidence of its efficacy has been incomplete, thereby resulting in continued controversy. Its antianginal effectiveness was investigated in 20 patients with documented coronary heart disease in a 44‐wk study incorporating a prolonged 12‐wk lead‐in period, individualization of P dosage in a 6‐wk dose‐finding period, and a 24‐wk double‐blind crossover phase. On double‐blind placebo, patients had 10.5 ± 2.1 anginal attacks and consumed 12.8 ± 3.0 nitroglycerin tablets (NTG) each week compared to 6.6 ± 1.5 anginal episodes (− 37%, p < 0.001) and 8.0 ± 1.7 NTG (− 38%, p < 0.001) when on P. No patient experienced more angina with P than with placebo. In addition, time to onset of chest pain during treadmill exercise was prolonged by P from 190 ± 16 to 248 ± 22 sec (+31%, p < 0.02) and ST depression was reduced from 1.7 ± 0.21 to 0.99 ± 0.18 mm (−42%, p < 0.05). There was correlation (r = 0.64, p < 0.01) between per cent declines in anginal frequency and resting double product with P. Thus, propranolol favorably altered several indices of myocardial ischemia in severe coronary heart disease. This investigation clearly documents the clinical efficacy of optimal beta adrenergic blockade in coronary disease and provides objective justification for the judicious application of propranolol in treatment of angina pectoris.