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A randomized blind cross-over study with placebo lead-in compared efficacy of calcium antagonists diltiazem and verapamil in 71 patients with stable angina concurrent with arterial hypotension (group 1) and 38 normotensive patients with ischemic heart disease (group 2). By acute bicycle exercise test evidence, verapamil was effective in 80% and 82% patients of group 1 and 2, respectively, dilitiazem--in 67 and 77%, respectively. Cumulation of the effect (p < 0.01) to the third month of verapamil course was comparable in both groups. Tolerance to an antianginal effect of dilitazem developed in 53% patients of group 1 (against 30% in group 2, p < 001) in 2-4 weeks of therapy (against 4-12 weeks in group 2, p < 0.05). By stress 199-T1 scintigraphy of the myocardium, administration of effective doses of diltiazem reduced the number of hypoperfused segments by at least 30%.

Aim: To compare antianginal efficacy and tolerability of propranolol therapy in patients with stable angina pectoris and chronic hypotension (Hpts) and normotensive patients with angina of effort (Npts)., Material and Methods: A randomized, single-blind, placebo-controlled study was made in 35 Hpts and 38 Npts was made using bicycle exercise tests, echocardiography, stress myocardial scintigraphy with 77-199., Results: Acute bicycle exercise tests showed high anti-ischemic activity of propranolol in 86% Hpts and 65% Npts. Stable antianginal propranolol effect in 57% Hpts was accompanied with a decrease of myocardial perfusion defect. Secondary resistance or pseudotolerance to an antianginal effect of propranolol was observed in 43% Hpts in 4-12 weeks (vs 0 of Npts; p < 0.01) as evidenced by T-199 stress myocardial scintigraphy. Hpts with secondary resistance and pseudotolerance to propranolol had lower control hypotension and bradicardia (p < 0.05), more anginal attacks (p < 0.001)., Conclusion: Hpts had rapidly developing secondary resistance and pseudotolerance to propranolol antianginal effect, bad tolerability of the drug.

A randomized single blind cross-over trial with placebo lead-in has been conducted in 71 anginal patients with arterial hypotension (group 1) and 38 ischemic heart disease patients with normal arterial pressure (group 2) to compare efficacy of therapy with isosorbide dinitrate (ID), sustac-forte (SF), isosorbide dinitrate retard (IDR) and trinitrolong (TN). Paired bicycle exercises revealed that in group 1 patients ID was low effective in 49%, SF--in 61%, IDR was highly effective in 97% and TN--in 96%. In group 1 tolerance to antianginal effect of ID, SF and IDR shown by stress myocardial scintigraphy with Tl-199 developed earlier--in 2-4 weeks in 63-70% patients (versus 22-27% in group 2; p < 0.01). Recovery of ID, SF, IDR effect required prolongation of the drug withdrawal period to 8-16 days (versus 3-5 days in group 2; p < 0.05). TN therapy remained effective for 3 months. Resistance to ID, SF in group 1 was relative and depended on dosage form of nitrates.

Aim: To compare effectiveness and tolerance of isosorbide dinitrate (ID) and molsidomin in retard forms in patients with effort angina (EA) in combination with arterial hypotension (AH)., Material and Methods: A randomised blind cross-over trial with lead-in placebo period trial compared efficiency of retard ID and molsidomin in 65 EA patients with AH (group 1) and 40 normotensive patients with coronary heart disease (group 2)., Results: Bicycle exercise has shown that retard ID and molsidomin retard were highly effective in group 1 (97% vs 92% 0 and group 2 (100 and 95%, respectively). Molsidomin retard treatment improved myocardial perfusion and was effective for a year in both groups., Conclusion: Retard ID was highly effective in anginal patients with AH but its tolerance is also high. Molsidomin retard is proposed as alternative treatment in anginal patients with AH.

Antianginal efficacy of atenolol (A) and isosorbide dinitrate (ID) was compared in a long-term randomized, single-blind, crossover, placebo controlled trial in 71 patients with combined stable angina pectoris and chronic hypotension (Hpts) and in 38 normotensive patients with angina of effort (Npts). Paired bicycle tests showed anti-ischemic activity of drugs: A in 75% and ID in 49% of Hpts, A in 83% and ID in 82% of Npts. Antianginal effect of 25 mg A was observed in 49% of Hpts (vs 6% of Npts; p < 0.01). Secondary resistance to A effect was developed on the treatment week 2-4 in 13% of Hpts (vs 0 in Npts) tolerance to ID effect--on week 1-2 in 71% of Hpts (vs 15% of Npts; p < 0.01) as evidenced by T1-199 exercise myocardial scintigraphy. Hpts needed individual ID therapy with a long-term ID-free period during 8-16 days (vs 3-5 in Npts; p < 0.05) to avoid tolerance. Stable antianginal ID effect manifested with a decrease of myocardial perfusion defect size by 43.1 +/- 1.3% (p < 0.05).

Aim: To study antiischemic and antianginal efficiency of adalat and its prolonged form adalat SL, dihydropiridin antagonists of calcium, in patients 1-3 years after surgical correction of stenosing coronary atherosclerosis., Material and Methods: The drugs were tried in 40 patients with angina of effort (functional class II-III) with a satisfactory inotropic function of the left ventricle 1 to 3 years after coronary artery bypass surgery (CABS). Myocardial circulation was measured with one-photon emission computed tomography using 99m-Tc-MIBI (CT)., Results: A 3-week therapy with adalat reduced the number of anginal attacks, nitroglycerin requirement, enhanced exercise tolerance. CT showed that myocardial blood flow significantly improved., Conclusion: Adalat proved to be effective in patients after CABS. Its prolonged form adalat SL is preferable.

In 88 patients with coronary heart disease and stable exercise-induced angina pectoris, the efficiency of calcium antagonists was examined by using myocardial Tl-199 scintigraphy and comparing its data with the parameters of angiography and their intracoronary injection. Three types of therapy-induced changes in myocardial perfusion were identified, which were as follows: 1) significant decreases in hypoperfusion area dimensions; 2) no changes in scintigraphic parameters, and 3) clinically asymptomatic increases in the number of hypoperfused sectors. There was a relationship between the therapy-induced changes and the number of sclerotic arteries though the ability of large coronary vessels to dilate was substantially decreased, as shown by angiopharmacological studies.