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European Heart Journal 1983 4(12):873-881;
Copyright © 1983 by the European Society of Cardiology.
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© 1983, by the European Society of Cardiology

Efficacy, duration and mechanism of action of nifedipine in stable exercise-induced angina pectoris

D. ARDISSINO, S. DE SERVI, J. A. SALERNO, G. SPECCHIA, M. PREVITALI, A. MUSSINI and P. BOBBA

Divisione di Cardiologia Policlinico S. Matteo Cattedra di Fisiopatologia Cadriorespiratoria Universit{acute} di Pavia Pavia, Italy

Received 17 September 1982; revised 23 March 1983; .

Address for Reprints: D. Ardissino, Cardiologia, Policlinico S. Matteo, I-277100 Pavia, Italy.

Abstract

The duration of effect of single oral doses of 10 and 20 mg of nifedipine was studied in 10 patients with angiographically proven coronary crtery disease and with stable exercise-induced angina pectoris.

In a randomized double-blind manner exercise tests were carried out 1 hour before and 1, 2, 4 and 6 h after the administration of placebo, nifedipine 10 mg(N10) and nifedipine 20 mg(N20). Compared with the placebo both N10 and N20 produced a statistically significant increase in exercise tolerance at l(P<0.05), 2(P<0.01), 4(P<0.01) and 6(P<0.05) hours after N10 and at l(P<0.01), 2(P<0.01), 4(P<0.01) and 6(P<0.05) hours after N20.

At peak exercise the product of heart rate x systolic blood pressure (RPP) was significantly increased compared with placebo at 2, 4 and 6 h after N10 and at 2, 4 and 6 h after N20 with maximal ST-segment depression unchanged. At the same duration of exercise at which angina had occurred during control studies the RPP was unaffected by nifedipine while a statistically significant reduction of ST-segment depression was seen at 1, 2 and 4 h after N10 and at 1, 2 and 4 h after N20.

Direct measurements of great cardiac vein flow during exercise in two patients showed that nifedipine is effective in preventing the abnormal increase of exercise-induced coronary tone in the area supplied by stenotic vessels.

These data document the prolonged antianginal effect of orally administered nifedipine and also suggest that the beneficial effect on exercise tolerance may be related to an increase in myocardial oxygen supply.

Key Words: Angina • exercise test • coronary blood flow


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