Felodipine Improves the Anti-Ischaemic Effect of Metoprolol in Stable Effort-Induced Angina

Abstract

The anti-ischaemic effects of sustained release felodipine 10 mg/day, metoprolol 200 mg/day and both drugs together were assessed in 16 male patients with stable effort-induced angina pectoris in a randomised double-blind crossover study. At the end of each 7-day treatment period, patients performed a maximum symptom-limited cycloergometer exercise test. All 3 active regimens significantly (p < 0.05) increased the ischaemic threshold (time to 1mm ST-segment depression) and exercise capacity (time to angina pain or exhaustion), and decreased ST-segment depression at maximum common workload vs placebo. The combination regimen produced a significantly greater effect on ischaemic threshold and ST-segment depression at maximum workload and maximum common workload than felodipine alone, and a greater effect on ST-segment depression at maximum common workload than metoprolol alone. Rate-pressure product at ischaemic threshold and maximum workload was increased by felodipine and decreased by metoprolol or the combination regimen. Thus, the combination of felodipine with metoprolol resulted in greater anti-ischaemic activity than that observed with either drug alone, reflecting their different, but complementary, mechanisms of action.