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A double-blind, randomized, placebo-controlled, crossover study tested peak and trough efficacy of immediate-release nisoldipine (20 mg twice daily) added to existent [beta]-andrenergic blocking therapy. Patients were randomized with a history of chronic stable angina, while receiving a stable regimen of a [beta]-blocking agent, with exercise test-induced angina in association with 1 mm horizontal or downsloping ST-segment depression and exercise test reproducibility of [+ or -] 15%. Ambulatory electrocardiographic monitoring (48-hour) was performed at 3 of 5 centers (44 patients). Efficacy was achieved in 53 patients (26 taking immediate-release nisoldipine/placebo in sequence and 27 taking placebo/immediate-release nisoldipine in sequence). Total exercise time increased compared with placebo at peak, but only a trend was seen at trough. Time to 1 mm ST-segment depression at peak and trough and ambulatory electrocardiographic parameters were also improved. Adverse effects were mild. This trial confirms that immediate-release nisoldipine when added to existent [beta]-blocker therapy is an active antianginal and anti-ischemic agent, but that the immediate-release formulation loses its antianginal effect at the end of its dosing interval (9 to 14 hours). This drug is therefore being examined in a new extended-release formulation (Coat-Core). (Am J Cardiol 1994;74:1165-1168)

Compared with placebo, adding betaxolol 20 mg every day to nifedipine (up to 60 mg/day in divided doses) or diltiazem (up to 360 mg/day in divided doses) for a 3-week treatment period in 135 patients with stable angina pectoris significantly (p

The efficacy and safety of extended-release isosorbide mononitrate tablets were evaluated in patients with stable effort angina. In a double-blind study, 313 patients with stable effort-induced angina were randomized to receive placebo or extended-release isosorbide mononitrate: 30, 60, 120 or 240 mg once daily in the morning, Serial exercise testing was performed using the standard Bruce treadmill protocol on days 1, 7, 14, 28 and 42 immediately before morning drug administration, and 4 and 12 hours after administration. After initial dosing, all groups that received extended-release isosorbide mononitrate had significant (p

Increasing knowledge of the complex mechanisms involved in maintaining normal vascular tone enable selection of targeted antianginal therapies. However, the individual response of each patient will direct the choice of medication used to alleviate ischemic symptoms. Moreover, an appreciation of risk reduction through diet and lipid-lowering efforts becomes more important as the dynamic and intricate roles of the endothelium and endothelium-derived relaxing factor in modulating vasomotor tone become apparent.

Dilevalol combines vasodilation due to selective [[beta].sub.2] agonism and nonselective [beta] antagonism. We studied 311 patients randomized to dilevalol and 138 to metoprolol in a multicenter trial. After a 4-week placebo washout, dilevalol was titrated from 200 to 1,600 mg once daily and metoprolol from 100 to 400 mg to a goal supine diastolic blood pressure

Using serial M-mode echocardiographic determinations of left ventricular (LV) mass and function, the effects of dilevalol, a selective [[beta].sub.2] agonist with nonselective [beta]-antagonist properties, were compared with those of metoprolol in 2 centers in double-blind, randomized clinical trials using similar protocols in nonelderly hypertensive patients (aged

Silent myocardial ischemia is characterized by asymptomatic periods of inadequate blood flow to the heart. There is disagreement about the prevalence (number of cases) of silent myocardial ischemia among different ethnic groups. This condition has rarely been reported among Chinese. There is also disagreement about the use of ambulatory electrocardiographic monitoring to diagnose symptomless ischemia. Twenty-four hour monitoring of 1,285 Chinese people was undertaken. Among the 251 persons who had a history of heart attack, almost half were found to have silent myocardial ischemia. Less than one-quarter of the 706 patients with angina (chest pain caused by myocardial ischemia) showed evidence of silent ischemia. Of the clinically normal subjects, under three percent had electrocardiographic evidence of ischemia. The group of Chinese patients with angina had fewer episodes of silent myocardial ischemia than found in other studies of angina patients; however, the prevalence of silent ischemia among the Chinese who had a prior heart attack was higher. The heart rate at the beginning of ST depression (an indication of ischemia, based on the electrocardiogram) was lower during ambulatory monitoring than during exercise testing. Ischemia during ambulatory monitoring was also less frequent than during exercise testing. While the Chinese patients were awake, silent myocardial ischemia occurred with relatively low work loads. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background: A majority of all myocardial infarctions occur in patients who are 65 years of age or older and have average cholesterol levels, but little information is available on whether cholesterol lowering in such patients reduces the rate of recurrent cardiovascular disease. Objective: To determine whether pravastatin reduces the rate of recurrent cardiovascular events in older patients. Design: Subset analysis of a randomized, controlled trial. Setting: 80 hospitals and affiliates in the United States and Canada. Patients: 1283 patients aged 65 to 75 years who had had myocardial infarction and had a plasma total cholesterol level less than 6.2 mmol/L (240 mg/dL) and a low-density lipoprotein cholesterol level of 3.0 to 4.5 mmol/L (115 to 174 mg/dL). Intervention: Pravastatin, 40 mg/d, or placebo. Measurements: Five-year event rates of major coronary events (coronary death, nonfatal myocardial infarction, angioplasty, or bypass surgery) and stroke. Results: Major coronary events occurred in 28.1% of placebo recipients and 19.7% of pravastatin recipients (difference, 9.0 percentage points [95% Cl, 4 to 13 percentage points]; relative risk reduction, 32%; P [is less than] 0.001). Coronary death occurred in 10.3% of the placebo group and in 5.8% of the pravastatin group (difference, 4.6 percentage points [Cl, 1.9 to 6.5 percentage points]; relative risk reduction, 45%; P = 0.004). Stroke incidence was 7.3% in the placebo group and 4.5% in the pravastatin group (absolute reduction, 2.9 percentage points [Cl, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03). The numbers of older patients needed to treat for 5 years were 11 (Cl, 8 to 24) to prevent a major coronary event and 22 (Cl, 15 to 53) to prevent a coronary death. For every 1000 older patients treated, 225 cardiovascular hospitalizations would be prevented compared with 121 hospitalizations in 1000 younger patients. Conclusions: In older patients with myocardial infarction and cholesterol levels in the average range, pravastatin is associated with a clinically important reduction in risk for major coronary events and stroke. Given the high cardiovascular event rate in older patients, the potential for absolute benefit in this age group is substantial., Pravastatin appears to reduce the risk of heart attacks and stroke in older patients with average levels of blood cholesterol and a previous heart attack. Pravastatin is a cholesterol-lowering drug. Researchers treated 1,283 elderly patients, with average cholesterol levels of 240 mg/dL, with either pravastatin or a placebo. In five years of study, 19.7% of patients taking pravastatin, and 28.1% of patients taking a placebo, had a heart attack or other major coronary event. Pravastatin treatment lowered the risk of heart attack by 45% and the stroke risk by 40% in this group of elderly patients.