Comparison of the anti-anginal efficacy of nicardipine and nifedipine in patients receiving atenolol: a randomized, double-blind, crossover study

Abstract

The effects of oral nicardipine (40 mg) and nifedipine (20 mg) in combination with atenolol (100 mg) were compared with those of placebo, oral nitroglycerin (0.4 mg) and atenolol alone (100 mg) in 17 patients with stable effort angina. Patients performed symptom-limited, multistage, upright bicycle ergometric exercises with computer-assisted ECG analysis in bipolar lead CM5. Nicardipine and nifedipine were given double blind and in randomized order. In comparison with placebo (4818 ± 2021 kpm), patients exercised longer and with a greater work load with nitroglycerin (5748 ± 1711 kpm, P < 0.001), the combinations of atenolol and nifedipine (6120 ± 2274 kpm, P < 0.05), and atenolol and nicardipine (6671 ± 2339 kpm, P < 0.01), but not with atenolol alone (5305 ± 1524 kpm, P = NS). The magnitude of ST-segment depression at peak exercise with placebo (3.22 ± 1.72 mm) was dramatically reduced with nitroglycerin (1.39 ± 1.87 mm) but less with atenolol alone (2.95 ± 1.83 mm, P < 0.05) or the combinations of atenolol and nicardipine (3.05 ± 1.51 mm, P = NS), and atenolol and nifedipine (2.45 ± 1.25 mm, P < 0.001). Compared to the combination of atenolol and nifedipine, that of atenolol and nicardipine produced a significantly ( P < 0.05) greater exercise tolerance (6671 ± 2339 versus 6120 ± 2274 kpm) but with a greater ST-segment depression at peak exercise (3.05 ± 1.51 versus 2.45 ± 1.29 mm, P < 0.01).