COMPARISON OF EFFICACY OF NISOLDIPINE, METOPROLOL, AND ISOSORBIDE DINITRATE IN PATIENTS WITH STABLE EXERTIONAL ANGINA - A RANDOMIZED, CROSS-OVER, PLACEBO-CONTROLLED STUDY

We evaluated the acute antianginal effect of oral nisoldipine (10 mg), metoprolol (40 mg), and long-acting isosorbide dinitrate (20 mg) in 1 5 patients with stable exertional angina. The patients performed sympt om-limited treadmill exercise at 2 h after the administration of place bo (Placebo stages 1 and 2) and each of the active drugs. After Placeb o stage 1, the patients were randomized for cross-over evaluation of t he acute effect of a single oral dose of placebo (Placebo stage 2), ni soldipine, metoprolol, or long-acting isosorbide dinitrate. All 15 pat ients developed angina during all of exercise tests and their exercise tests were terminated at the onset of angina. The time until developm ent of 0.1 mV ST segment depression was increased by ah three drugs co mpared to placebo, and it was significantly longer with metoprolol tha n with isosorbide dinitrate. Similarly, the time to ceasing exercise b ecause of angina was also prolonged by all three drugs. The exercise t ime was longer with nisoldipine and metoprolol compared to isosorbide dinitrate, but there was no significant difference between nisoldipine and metoprolol. In conclusion, metoprolol and nisoldipine more effect ively prolonged exercise compared to long-acting isosorbide dinitrate in patients with stable exertional angina.