Purpose: This study was conducted to determine whether amlodipine has an additive anti-ischaemic effect to atenolol in postinfarction patients with stable exercise induced ischaemia.
Methods: 35 postinfarction ([is less than] 3 months) patients, aged 54 to 75 years, with an ejection fraction [is greater than] 40% and documented stable exertional ischemia (symptomatic or asymptomatic) were randomised to either atenolol 50 mg twice daily plus amlodipine 10 mg once daily (group I, n = 18) or atenolol 50 mg twice daily plus placebo (group II, n = 17). All patients underwent a treadmill exercise echocardiography after 14 days of single-blind placebo run - in and after 4 weeks of double-blind active treatment.
Results: At baseline, all patients showed exercise induced ST segment depression; exertional angina was present in 16 of 18 (88%) group I patients and in 11 of 17 (64%) group II patients. After treatment, 12 of 18 (66%) group I patients and 14 of 17 (82%) group II patients still showed ST depression (p = not significant). Total exercise time and ischaemic threshold significantly improved (p [is less than] 0,01) and the total amount of ST segment depression as well as recovery time significantly decreased (p [is less than] 0,05) in both groups after treatment. Although exertional angina was completely controlled more frequently in group I (11 of 14; 77%) than in group II patients (2 of 9; 22%), the difference was not significantly. Wall motion abnormalities at rest were present in all patients. After treatment the resting wall motion score index (WMSI) significantly improved only in group I patients (p [is less than] 0,01), while peak exercise WMSI improved in both groups (p [is less than] 0,01).
Conclusion: In patients with stable exercise - induced ischaemia the combined therapy with amlodipine and atenolol is more effective in controlling angina and improving the ischaemic threshold and the resting contractility pattern than atenolol plus placebo.
Clinical Implications: These findings suggest that combination therapy with amlodipine and atenolol may have clinical advantages over atenolol monotherapy in patients with stable effort - induced ischaemia.
Supported by: Pfizer Pharmaceuticals
Djoko Trihadi(*) and R Hardjalukita. Department of Internal Medicine, Municipal Hospital, Semarang, Central Java, Indonesia.
COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group
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