ATENOLOL OR NICARDIPINE ALONE IS AS EFFICACIOUS IN STABLE ANGINA AS THEIR COMBINATION - A DOUBLE-BLIND RANDOMIZED TRIAL

Background: Beta blockers and calcium antagonists are widely used in t he management of angina pectoris in the belief that the combination is more efficacious than either drug alone. Methods: This double blind r andomised crossover placebo controlled study compares the effects of n icardipine, atenolol and their combination in 30 patients with chronic stable angina. Each treatment period lasted 6 weeks with dose titrati on after 3 weeks. Symptom limited treadmill exercise testing and radio nuclide ventriculography at rest was carried out at the end of each tr eatment period. Results: Total exercise duration and time to 1-mm ST-s egment depression was significantly prolonged by nicardipine and ateno lol when compared to placebo, the combination offered no additional be nefit. Time to onset of-angina was significantly prolonged by nicardip ine and the combination but not by atenolol. Indices of left ventricul ar function were not significantly affected by any treatment other tha n an increase in left ventricular end diastolic volume on atenolol and the combination. Conclusions: Nicardipine and atenolol are equally ef fective in prolonging exercise duration and time to onset of ischemia in patients with chronic stable angina while the combination appeared to offer no additional benefit. Nicardipine prolonged the time to onse t of angina significantly; again there was no further improvement with the combination. Neither drug appears to have an important effect on the parameters of diastolic function studied in patients with chronic stable angina.