Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort: A randomized, double-blind, crossover study

Michael D. Winniford, Kay L. Fulton, James R. Corbett, Charles H. Croft, L. David Hillis

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

To compare a propranolol-verapamil with a propranolol-nifedipine combination in patients with severe angina of effort, 16 patients (11 men and 5 women, aged 56 ± 8 years [mean ± standard deviation]) with more than 5 episodes/week of angina and a positive exercise tolerance test despite propranolol (229 ± 44 mg/day [range 180 to 360]) were maintained on this dose of propranolol and, in addition, received verapamil (360 mg/day) and nifedipine (60 mg/day) for 3 weeks each in a double-blind, randomized fashion. In comparison with propranolol alone, anginal frequency and nitroglycerin usage were reduced by propranolol-verapamil but not by propranolol-nifedipine. Exercise time (standard Bruce protocol) was similar for the 2 combinations (6.4 ± 2.0 minutes with propranol-olverapamil, 6.6 ± 2.1 minutes with propranolol-nifedipine, difference not significant), but the magnitude of ST-segment depression at peak exercise was less (p < 0.05) during propranolol-verapamil (0.03 ± 0.06 mV) than during propranolol alone (0.18 ± 0.07 mV) and propranolol-nifedipine (0.08 ± 0.07 mV). Left ventricular ejection fraction at rest was higher (p < 0.05) with propranolol-nifedipine (0.62 ± 0.10) than with propranolol-verapamil (0.58 ± 0.10), but neither differed from ejection fraction at rest with propranolol alone (0.59 ± 0.08). Ejection fraction at peak exercise was similar during all 3 periods. In 2 patients, verapamil caused weakness, lightheadedness, and severe sinus bradycardia (40 to 48 beats/min), and the dosage was reduced (blindly) to 240 mg/day, with the alleviation of bradycardia and associated symptoms. Thus, in patients with severe angina of effort with propranolol alone, the addition of verapamil is more effective than the addition of nifedipine in reducing anginal frequency, nitroglycerin usage, and the magnitude of the electrocardiographic response to exercise. Although both combinations are generally safe and well-tolerated, in an occasional patient symptomatic sinus bradycardia develops during therapy with propranolol-verapamil; therefore, this combination must be given carefully.

Original languageEnglish (US)
Pages (from-to)281-285
Number of pages5
JournalThe American Journal of Cardiology
Volume55
Issue number4
DOIs
StatePublished - Feb 1 1985
Externally publishedYes

Fingerprint

Angina Pectoris
Nifedipine
Verapamil
Double-Blind Method
Propranolol
Cross-Over Studies
Bradycardia
Exercise
Nitroglycerin
Exercise Tolerance
Dizziness
Exercise Test
Stroke Volume

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort : A randomized, double-blind, crossover study. / Winniford, Michael D.; Fulton, Kay L.; Corbett, James R.; Croft, Charles H.; Hillis, L. David.

In: The American Journal of Cardiology, Vol. 55, No. 4, 01.02.1985, p. 281-285.

Research output: Contribution to journalArticle

Winniford, Michael D. ; Fulton, Kay L. ; Corbett, James R. ; Croft, Charles H. ; Hillis, L. David. / Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort : A randomized, double-blind, crossover study. In: The American Journal of Cardiology. 1985 ; Vol. 55, No. 4. pp. 281-285.
@article{5f2286f34b24424a9707de0204cb67f4,
title = "Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort: A randomized, double-blind, crossover study",
abstract = "To compare a propranolol-verapamil with a propranolol-nifedipine combination in patients with severe angina of effort, 16 patients (11 men and 5 women, aged 56 ± 8 years [mean ± standard deviation]) with more than 5 episodes/week of angina and a positive exercise tolerance test despite propranolol (229 ± 44 mg/day [range 180 to 360]) were maintained on this dose of propranolol and, in addition, received verapamil (360 mg/day) and nifedipine (60 mg/day) for 3 weeks each in a double-blind, randomized fashion. In comparison with propranolol alone, anginal frequency and nitroglycerin usage were reduced by propranolol-verapamil but not by propranolol-nifedipine. Exercise time (standard Bruce protocol) was similar for the 2 combinations (6.4 ± 2.0 minutes with propranol-olverapamil, 6.6 ± 2.1 minutes with propranolol-nifedipine, difference not significant), but the magnitude of ST-segment depression at peak exercise was less (p < 0.05) during propranolol-verapamil (0.03 ± 0.06 mV) than during propranolol alone (0.18 ± 0.07 mV) and propranolol-nifedipine (0.08 ± 0.07 mV). Left ventricular ejection fraction at rest was higher (p < 0.05) with propranolol-nifedipine (0.62 ± 0.10) than with propranolol-verapamil (0.58 ± 0.10), but neither differed from ejection fraction at rest with propranolol alone (0.59 ± 0.08). Ejection fraction at peak exercise was similar during all 3 periods. In 2 patients, verapamil caused weakness, lightheadedness, and severe sinus bradycardia (40 to 48 beats/min), and the dosage was reduced (blindly) to 240 mg/day, with the alleviation of bradycardia and associated symptoms. Thus, in patients with severe angina of effort with propranolol alone, the addition of verapamil is more effective than the addition of nifedipine in reducing anginal frequency, nitroglycerin usage, and the magnitude of the electrocardiographic response to exercise. Although both combinations are generally safe and well-tolerated, in an occasional patient symptomatic sinus bradycardia develops during therapy with propranolol-verapamil; therefore, this combination must be given carefully.",
author = "Winniford, {Michael D.} and Fulton, {Kay L.} and Corbett, {James R.} and Croft, {Charles H.} and Hillis, {L. David}",
year = "1985",
month = "2",
day = "1",
doi = "10.1016/0002-9149(85)90361-3",
language = "English (US)",
volume = "55",
pages = "281--285",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort

T2 - A randomized, double-blind, crossover study

AU - Winniford, Michael D.

AU - Fulton, Kay L.

AU - Corbett, James R.

AU - Croft, Charles H.

AU - Hillis, L. David

PY - 1985/2/1

Y1 - 1985/2/1

N2 - To compare a propranolol-verapamil with a propranolol-nifedipine combination in patients with severe angina of effort, 16 patients (11 men and 5 women, aged 56 ± 8 years [mean ± standard deviation]) with more than 5 episodes/week of angina and a positive exercise tolerance test despite propranolol (229 ± 44 mg/day [range 180 to 360]) were maintained on this dose of propranolol and, in addition, received verapamil (360 mg/day) and nifedipine (60 mg/day) for 3 weeks each in a double-blind, randomized fashion. In comparison with propranolol alone, anginal frequency and nitroglycerin usage were reduced by propranolol-verapamil but not by propranolol-nifedipine. Exercise time (standard Bruce protocol) was similar for the 2 combinations (6.4 ± 2.0 minutes with propranol-olverapamil, 6.6 ± 2.1 minutes with propranolol-nifedipine, difference not significant), but the magnitude of ST-segment depression at peak exercise was less (p < 0.05) during propranolol-verapamil (0.03 ± 0.06 mV) than during propranolol alone (0.18 ± 0.07 mV) and propranolol-nifedipine (0.08 ± 0.07 mV). Left ventricular ejection fraction at rest was higher (p < 0.05) with propranolol-nifedipine (0.62 ± 0.10) than with propranolol-verapamil (0.58 ± 0.10), but neither differed from ejection fraction at rest with propranolol alone (0.59 ± 0.08). Ejection fraction at peak exercise was similar during all 3 periods. In 2 patients, verapamil caused weakness, lightheadedness, and severe sinus bradycardia (40 to 48 beats/min), and the dosage was reduced (blindly) to 240 mg/day, with the alleviation of bradycardia and associated symptoms. Thus, in patients with severe angina of effort with propranolol alone, the addition of verapamil is more effective than the addition of nifedipine in reducing anginal frequency, nitroglycerin usage, and the magnitude of the electrocardiographic response to exercise. Although both combinations are generally safe and well-tolerated, in an occasional patient symptomatic sinus bradycardia develops during therapy with propranolol-verapamil; therefore, this combination must be given carefully.

AB - To compare a propranolol-verapamil with a propranolol-nifedipine combination in patients with severe angina of effort, 16 patients (11 men and 5 women, aged 56 ± 8 years [mean ± standard deviation]) with more than 5 episodes/week of angina and a positive exercise tolerance test despite propranolol (229 ± 44 mg/day [range 180 to 360]) were maintained on this dose of propranolol and, in addition, received verapamil (360 mg/day) and nifedipine (60 mg/day) for 3 weeks each in a double-blind, randomized fashion. In comparison with propranolol alone, anginal frequency and nitroglycerin usage were reduced by propranolol-verapamil but not by propranolol-nifedipine. Exercise time (standard Bruce protocol) was similar for the 2 combinations (6.4 ± 2.0 minutes with propranol-olverapamil, 6.6 ± 2.1 minutes with propranolol-nifedipine, difference not significant), but the magnitude of ST-segment depression at peak exercise was less (p < 0.05) during propranolol-verapamil (0.03 ± 0.06 mV) than during propranolol alone (0.18 ± 0.07 mV) and propranolol-nifedipine (0.08 ± 0.07 mV). Left ventricular ejection fraction at rest was higher (p < 0.05) with propranolol-nifedipine (0.62 ± 0.10) than with propranolol-verapamil (0.58 ± 0.10), but neither differed from ejection fraction at rest with propranolol alone (0.59 ± 0.08). Ejection fraction at peak exercise was similar during all 3 periods. In 2 patients, verapamil caused weakness, lightheadedness, and severe sinus bradycardia (40 to 48 beats/min), and the dosage was reduced (blindly) to 240 mg/day, with the alleviation of bradycardia and associated symptoms. Thus, in patients with severe angina of effort with propranolol alone, the addition of verapamil is more effective than the addition of nifedipine in reducing anginal frequency, nitroglycerin usage, and the magnitude of the electrocardiographic response to exercise. Although both combinations are generally safe and well-tolerated, in an occasional patient symptomatic sinus bradycardia develops during therapy with propranolol-verapamil; therefore, this combination must be given carefully.

UR - http://www.scopus.com/inward/record.url?scp=0021968628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0021968628&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(85)90361-3

DO - 10.1016/0002-9149(85)90361-3

M3 - Article

C2 - 3969862

AN - SCOPUS:0021968628

VL - 55

SP - 281

EP - 285

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 4

ER -