Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
A double-blind comparison of a beta-blocker and a potassium channel opener in exercise induced angina
The Department of Cardiology, Northwick Park Hospital and Clinical Research Centre Watford Road, Harrow, Middlesex, U.K.
Correspondence: E. B. Raftery, The Department of Cardiology, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, U.K.
This randomized, double-blind, parallel study compared the anti-anginal effects of nicorandil and atenolol in 37 patients with exercise-induced angina pectoris. At the end of a single-blind placebo period, patients were randomized and received either atenolol 50 mg o.d. or nicorandil 10 mg b.d.for 3 weeks. On the third week, the dosage was increased (nicorandil 20 mg b.d. or atenolol 100 mg o.d.) for the final 3-week period. Treadmill exercise tolerance tests were performed immediately before and 2 h after dosing at the end of the placebo period, and at the end of the third and sixth week of active treatment.
Demographic characteristics and exercise performance with placebo were comparable between both treatment groups, and at the end of the treatment periods a significant improvement in exercise time was observed; an increase in the time to peak exercise of 1.33 ± 0.29 min (mean±standard error of the mean) in atenolol-treatedpatients (P<0.00l), and of 1.47 – 0.40 min (P<0.005) in nicorandil-treated patients. While the anti-anginal activity of the two drugs was comparable, their effects on the rate-pressure product heart rate x systolic blood pressure were clearly different; atenolol induced a decrease at peak exercise, but this parameter was not changed or was slightly increased with nicorandil. One patient with severe three-vessel disease died suddenly after 3 days of treatment with nicorandil 10 mg twice daily. The most frequent adverse effect in both groups was headache, which led to discontinuation of one patient in the atenolol group and of five patients in the nicorandil group.
We have shown that nicorandil is as equally efficacious as atenolol in the management of chronic stable angina, although its mode of action is completely different. This suggests that nicorandil may be suitable for the management of anginal subjects in whom β-blockade is contra-indicated. The possible combination of nicorandil and atenolol remains to be explored.
Key Words: Nicorandil • atenolol • angina pectoris • potassium channel openers • β blockers
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