Table 8.1BB vs. BB + CCB for stable angina

Quality assessmentSummary of findings
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsBBBB +CCBRelative (95% CI)Absolute
Exercise time (min) (follow-up 10 weeks-6 months; better indicated by higher values) (propranolol vs. propranolol+nifedipine; propranolol vs. propranolol+dilitazem; propranolol vs. propranolol+nifedipine)
Tweddel 198141; O’Hara 198726; Kawanishi 199227randomised trialsserious (a)no serious inconsistencyno serious indirectnessserious (b)none7341-MD 0.89 lower (1.67 to 0.11 lower)⊕⊕○○

LOW
Time to onset of angina (min) – (propranolol vs. propranolol+nifedipine) (follow-up 6 months; better indicated by highervalues)
Kawanishi 199227(k)randomised trialsserious (c)no serious inconsistencyno serious indirectnessserious (b)none2116-MD 0.2 higher (1.13 lower to 1.53 higher)⊕⊕○○

LOW
Angina attacks/week (follow-up 10weeks-6 months; better indicated by lower values) (propranolol vs. propranolol+nifedipine; metoprolol vs. metoprolol+nifedipine)
Kawanishi 199227; Savonitto 199628 (IMAGE)randomised trialsserious (d)no serious inconsistencyno serious indirectnessno serious imprecisionnone8277-MD 0.43 higher (0.56 lower to 1.41 higher)⊕⊕⊕○

MODERATE
Angina attacks/day –(propranolol vs. propranolol+nifedipine )(follow-up 10 weeks; better indicated by lower values)
Tweddel 198141randomised trialsserious (e)no serious inconsistencyno serious indirectnessserious (b)none1818-MD 3 higher (2.49 lower to 8.49 higher)⊕⊕○○

LOW
Nitroglycerin tablets/week –(propranolol vs. propranolol+nifedipine) (follow-up 6 months; better indicated by lower values)
Kawanishi 199227randomised trialsserious (c)no serious inconsistencyno serious indirectnessno serious imprecisionnone2116-MD 0.4 higher (0.15 lower to 0.95 higher)⊕⊕⊕○

MODERATE
Cardiac death – (atenolol vs. atenolol+nifedipine) (follow-up mean 2 years)
Dargie 199631 (TIBET)randomised trialsserious (f)no serious inconsistencyno serious indirectnessserious (g)none3/226 (1.3%)4/224 (1.8%)RR 0.74 (0.17 to 3.28)5 fewer per 1000 (from 15 fewer to 41 more)⊕⊕○○

LOW
Non fatal MI – (atenolol vs. atenolol+nifedipine) (follow-up mean 2 years)
Dargie 199631 (TIBET)randomised trialsserious (f)no serious inconsistencyno serious indirectnessserious (g)none14/226 (6.2%)7/224 (3.1%)RR 1.98 (0.82 to 4.82)31 more per 1000 (from 6 fewer to 119 more)⊕⊕○○

LOW
Withdrawals due to side effects – (atenolol vs. atenolol+nifedipine) (follow-up mean 2 years)
Dargie 199631 (TIBET) (j)randomised trialsserious (f)no serious inconsistencyno serious indirectnessserious (g)none60/226 (26.5%)64/224 (28.6%)RR 0.93 (0.69 to 1.25)20 fewer per 1000 (from 89 fewer to 71 more)⊕⊕○○

LOW
Adverse effects (overall) – (atenolol vs. atenolol+amlodipine) (follow-up 10 weeks)
Pehrsson 200034randomised trialsserious (h)no serious inconsistencyno serious indirectnessserious (g)none52/116 (44.8%)59/119 (49.6%)RR 0.9 (0.69 to 1.19)50 fewer per 1000 (from 154 fewer to 94 more)⊕⊕○○

LOW
Time to 1mm ST depression (sec)- (metoprolol vs. metoprolol+nifedipine) (follow-up 10 weeks; better indicated by higher values)
Savonitto 199628 (IMAGE)randomised trialsserious (i)no serious inconsistencyno serious indirectnessserious (b)none6563-MD 59 lower (107.3 to 10.7 lower)⊕⊕○○

LOW
a

O’Hara 1987[25]: Randomised cross over trial. Double blind. Allocation concealment not reported. Baseline characteristics not reported. Drop out >20% (32%). Intention to treat analysis not reported. Kawanishi 1992[26]: Randomised. Double blind. Allocation concealment not reported. Baseline comparisons made. Drop out < 20% (2.8% in nifedipine group and 2.6% in propronolol group). Intention to treat analysis not reported. Tweddel 1981[40]: Randomised cross over trial. Double blind. Baseline characteristics not reported. Allocation concealment not reported. Drop-out >20% (28%). Intention to treat analysis not reported.

b

95% CI includes no effect and the upper and lower CI crosses the MID.

c

Kawanishi 1992[26] : Randomised. Double blind. Allocation concealment not reported. Baseline comparisons made. Drop out < 20% (2.8% in nifedipine group and 2.6% in propronolol group). Intention to treat analysis not reported.

d

Kawanishi 1992[26]: Randomised. Double blind. Allocation concealment not reported. Baseline comparisons made. Drop out < 20% (2.8% in nifedipine group and 2.6% in propronolol group). Intention to treat analysis not reported. Savonitto 1996[27]: Randomised. Double blind. Allocation concealment not reported. Baseline comparison made. Drop out <20% (11%). Intention to treat analysis not reported.

e

Tweddel 1981[40]: Randomised cross over trial. Double blind. Baseline characteristics not reported. Allocation concealment not reported. Drop-out >20% (28%). Intention to treat analysis not reported.

f

Dargie 1996[31] (TIBET): Randomised. Double blind. Allocation concealment not reported. Baseline comparisons made. Drop-out >20% [60(27%) for atenolol, 93 (40%) for nifedipine, 64 (29%) for their combination]. Intention to treat analysis reported.

g

95% CI around the pooled estimate of effect includes both: 1) no effect and 2) appreciable benefit or appreciable harm.

h

Pehrsson 2000[33]: Randomised. Double blind. Allocation concealment not reported. Drop out <20% Baseline comparisons made. Intention to treat analysis not reported.

i

Savonitto 1996[27]: Randomised. Double blind. Allocation concealment not reported. Baseline comparison made. Drop out <20% (11%). Intention to treat analysis not reported.

j

Not reported what were the side effects

k

At baseline (n= 74 participants): NYHA angina class I (4%), class II (73%), class III (23%)

From: 8, Combination of beta blockers and calcium channel blockers

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

The rights of the National Clinical Guidelines Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.