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Br Heart J. 1987 April; 57(4): 336–343. | PMCID: PMC1277172 |
A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris. I N Findlay, K MacLeod, G Gillen, A T Elliott, T Aitchison, and H J Dargie Abstract The efficacy and effect on cardiac function of verapamil 120 mg three times a day and atenolol 100 mg once a day, singly and in combination, were evaluated in 15 patients with angina pectoris. While they were on the combination treatment four patients withdrew from the study. Episodes of angina pectoris and glyceryl trinitrate consumption were significantly reduced only on the combination. On the combination only four patients developed evidence of ischaemia during exercise compared with seven on verapamil and ten on atenolol. ST segment depression at peak exercise, assessed by 16 point precordial mapping, was reduced by all active treatments from 7.1 on placebo to 2.7, 0.9, and 0.6 mm on atenolol, verapamil, and the combination respectively. Mean left ventricular ejection fraction fell significantly from 60% on placebo to 53% on the combination but was unchanged on verapamil and atenolol. Verapamil was an effective alternative to atenolol; the combination was the most effective treatment but was associated with a significant morbidity. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. - Leon MB, Rosing DR, Bonow RO, Lipson LC, Epstein SE. Clinical efficacy of verapamil alone and combined with propranolol in treating patients with chronic stable angina pectoris. Am J Cardiol. 1981 Jul;48(1):131–139. [PubMed]
- Dargie HJ, Lynch PG, Krikler DM, Harris L, Krikler S. Nifedipine and propranolol: a beneficial drug interaction. Am J Med. 1981 Oct;71(4):676–682. [PubMed]
- Johnson SM, Mauritson DR, Corbett JR, Woodward W, Willerson JT, Hillis LD. Double-blind, randomized, placebo-controlled comparison of propranolol and verapamil in the treatment of patients with stable angina pectoris. Am J Med. 1981 Sep;71(3):443–451. [PubMed]
- Opie LH. Calcium antagonists. Mechanisms, therapeutic indications and reservations: a review. Q J Med. 1984 Winter;53(209):1–16. [PubMed]
- Findlay IN, MacLeod K, Ford M, Gillen G, Elliott AT, Dargie HJ. Treatment of angina pectoris with nifedipine and atenolol: efficacy and effect on cardiac function. Br Heart J. 1986 Mar;55(3):240–245. [PubMed]
- Tweddel AC, Beattie JM, Murray RG, Hutton I. The combination of nifedipine and propranolol in the management of patients with angina pectoris. Br J Clin Pharmacol. 1981 Aug;12(2):229–233. [PubMed]
- Rowland E, Razis P, Sugrue D, Krikler DM. Acute and chronic haemodynamic and electrophysiological effects of nifedipine in patients receiving atenolol. Br Heart J. 1983 Oct;50(4):383–389. [PubMed]
- Winniford MD, Huxley RL, Hillis LD. Randomized, double-blind comparison of propranolol alone and a propranolol-verapamil combination in patients with severe angina of effort. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):492–498. [PubMed]
- Johnston DL, Gebhardt VA, Donald A, Kostuk WJ. Comparative effects of propranolol and verapamil alone and in combination on left ventricular function and volumes in patients with chronic exertional angina: a double-blind, placebo-controlled, randomized, crossover study with radionuclide ventriculography. Circulation. 1983 Dec;68(6):1280–1289. [PubMed]
- Fox K, Selwyn A, Shillingford J. Precordial electrocardiographic mapping after exercise in the diagnosis of coronary artery disease. Am J Cardiol. 1979 Mar;43(3):541–546. [PubMed]
- Bhamra RK, Thorley KJ, Vale JA, Holt DW. High-performance liquid chromatographic measurement of atenolol: methodology and clinical applications. Ther Drug Monit. 1983;5(3):313–318. [PubMed]
- Cole SC, Flanagan RJ, Johnston A, Holt DW. Rapid high-performance liquid chromatographic method for the measurement of verapamil and norverapamil in blood plasma or serum. J Chromatogr. 1981 Nov 20;218:621–629. [PubMed]
- Ball SG, Tree M, Morton JJ, Inglis GC, Fraser R. Circulating dopamine: its effect on the plasma concentrations of catecholamines, renin, angiotensin, aldosterone and vasopressin in the conscious dog. Clin Sci (Lond). 1981 Oct;61(4):417–422. [PubMed]
- Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research. Circ Res. 1980 Jul;47(1):1–9. [PubMed]
- Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. [PubMed]
- Subramanian VB, Lahiri A, Paramasivan R, Raftery EB. Verapamil in chronic stable angina. A controlled study with computerized multistage treadmill exercise. Lancet. 1980 Apr 19;1(8173):841–844. [PubMed]
- Sadick NN, Tan AT, Fletcher PJ, Morris J, Kelly DT. A double-blind randomized trial of propranolol and verapamil in the treatment of effort angina. Circulation. 1982 Sep;66(3):574–579. [PubMed]
- Josephson MA, Hecht HS, Hopkins J, Guerrero J, Singh BN. Comparative effects of oral verapamil and propranolol on exercise-induced myocardial ischemia and energetics in patients with coronary artery disease: single-blind placebo crossover evaluation using radionuclide ventriculography. Am Heart J. 1982 Jun;103(6):978–985. [PubMed]
- Arnman K, Rydén L. Comparison of metoprolol and verapamil in the treatment of angina pectoris. Am J Cardiol. 1982 Mar;49(4):821–827. [PubMed]
- Bonow RO, Leon MB, Rosing DR, Kent KM, Lipson LC, Bacharach SL, Green MV, Epstein SE. Effects of verapamil and propranolol on left ventricular systolic function and diastolic filling in patients with coronary artery disease: radionuclide angiographic studies at rest and during exercise. Circulation. 1982 Jun;65(7):1337–1350. [PubMed]
- Singh BN, Chew CY, Josephson MA, Packer M. Part I: pharmacologic and hemodynamic actions and interactions. Pharmacologic and hemodynamic mechanisms underlying the antianginal actions of verapamil. Am J Cardiol. 1982 Oct;50(4):886–893. [PubMed]
- Winniford MD, Fulton KL, Corbett JR, Croft CH, Hillis LD. Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort: a randomized, double-blind, crossover study. Am J Cardiol. 1985 Feb 1;55(4):281–285. [PubMed]
- Frishman W, Kirsten E, Klein M, Pine M, Johnson SM, Hillis LD, Packer M, Kates R. Clinical relevance of verapamil plasma levels in stable angina pectoris. Am J Cardiol. 1982 Nov;50(5):1180–1184. [PubMed]
- Henry PD. Comparative pharmacology of calcium antagonists: nifedipine, verapamil and diltiazem. Am J Cardiol. 1980 Dec 1;46(6):1047–1058. [PubMed]
- Cruickshank JM. The clinical importance of cardioselectivity and lipophilicity in beta blockers. Am Heart J. 1980 Aug;100(2):160–178. [PubMed]
- McLean AJ, Knight R, Harrison PM, Harper RW. Clearance-based oral drug interaction between verapamil and metoprolol and comparison with atenolol. Am J Cardiol. 1985 Jun 1;55(13 Pt 1):1628–1629. [PubMed]
- Warrington SJ, Holt D, Johnston A, Fitzsimons TJ. Pharmacokinetics and pharmacodynamics of verapamil in combination with atenolol, metoprolol and propranolol. Br J Clin Pharmacol. 1984;17 (Suppl 1):37S–44S. [PubMed]
- Subramanian B, Bowles MJ, Davies AB, Raftery EB. Combined therapy with verapamil and propranolol in chronic stable angina. Am J Cardiol. 1982 Jan;49(1):125–132. [PubMed]
- Wayne VS, Harper RW, Laufer E, Federman J, Anderson ST, Pitt A. Adverse interaction between beta-adrenergic blocking drugs and verapamil--report of three cases. Aust N Z J Med. 1982 Aug;12(4):285–289. [PubMed]
- Hutchison SJ, Lorimer AR, Lakhdar A, McAlpine SG. Beta blockers and verapamil: a cautionary tale. Br Med J (Clin Res Ed). 1984 Sep 15;289(6446):659–660. [PubMed]
- Lessem J. Combined therapy with Ca-antagonists and beta-adrenergic receptor blocking agents in chronic stable angina. Acta Med Scand Suppl. 1984;681:83–90. [PubMed]
- McGourty JC, Silas JH, Solomon SA. Tolerability of combined treatment with verapamil and beta-blockers in angina resistant to monotherapy. Postgrad Med J. 1985 Mar;61(713):229–232. [PubMed]
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