Comparison of nicardipine and verapamil in the management of chronic stable angina

Abstract

Twenty-two patients with stable angina were studied in a randomised double-blind, placebo-controlled crossover trial to compare the antianginal effects of nicardipine (30 mg) and verapamil (120 mg), each given three times a day. Efficacy was assessed using treadmill exercise testing and 24-hour ambulatory electrocardiographic monitoring performed after an initial 2-week placebo phase and at the end of each 4-week active treatment period. Exercise time (mean ± standard error of mean) increased from 7.4 ± 0.5 min on placebo to 8.4 ± 0.7 min on nicardipine ( P < 0.05) and to 9.9 ± 0.7 min on verapamil ( P < 0.001). Resting heart rate was decreased by verapamil ( P < 0.002) and increased by nicardipine ( P < 0.02). Exercise heart rate was increased on nicardipine ( P < 0.005) but heart rate gain was higher on verapamil ( P < 0.01). Blood pressure and peak ST segment depression were unaltered by either drug but the time to 1 mm ST segment depression increased on both drugs. Ambulatory heart rates were lower on verapamil than on nicardipine and patient subjective preference was in favour of verapamil. This study confirms that both nicardipine and verapamil improve exercise capacity, but verapamil produces a greater improvement in exercise tolerance and indices of myocardial ischaemia whilst nicardipine is associated with an increase in the number of episodes of ST segment depression on ambulatory monitoring.