European Heart Journal Advance Access originally published online on October 7, 2005
European Heart Journal 2005 26(23):2529-2536; doi:10.1093/eurheartj/ehi586
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Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina
1Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada
2University of Glasgow, Scotland, UK
3Slaska Akademia Medyczna, Katowice, Poland
4Royal Brompton Hospital, London, UK
Received 13 June 2005; revised 16 September 2005; accepted 22 September 2005; online publish-ahead-of-print 7 October 2005.
* Corresponding author. Tel: +514 376 3330 ext. 3564; fax: +514 376 1355. E-mail address: jean-claude.tardif{at}icm-mhi.org
See page 2482 for the editorial comment on this article (doi:10.1093/eurheartj/ehi575)
Aims Ivabradine, a new If inhibitor which acts specifically on the pacemaker activity of the sinoatrial node, is a pure heart rate lowering agent. Ivabradine has shown anti-ischaemic and anti-anginal activity in a placebo-controlled trial. The objective of this study was to compare the anti-anginal and anti-ischaemic effects of ivabradine and the beta-blocker atenolol.
Methods and results In a double-blinded trial, 939 patients with stable angina were randomized to receive ivabradine 5 mg bid for 4 weeks and then either 7.5 or 10 mg bid for 12 weeks or atenolol 50 mg od for 4 weeks and then 100 mg od for 12 weeks. Patients underwent treadmill exercise tests at randomization (M0) and after 4 (M1) and 16 (M4) weeks of therapy. Increases in total exercise duration (TED) at trough at M4 were 86.8±129.0 and 91.7±118.8 s with ivabradine 7.5 and 10 mg, respectively and 78.8±133.4 s with atenolol 100 mg. Mean differences (SE) when compared with atenolol 100 mg were 10.3 (9.4) and 15.7 (9.5) s in favour of ivabradine 7.5 and 10 mg (P<0.001 for non-inferiority). TED at M1 improved by 64.2±104.0 s with ivabradine 5 mg and by 60.0±114.4 s with atenolol 50 mg (P<0.001 for non-inferiority). Non-inferiority of ivabradine was shown at all doses and for all criteria. The number of angina attacks was decreased by two-thirds with both ivabradine and atenolol.
Conclusion Ivabradine is as effective as atenolol in patients with stable angina.
Key Words: Angina • Heart rate • Pharmacology
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