Long-term oral verapamil therapy in patients with rest angina

Abstract

Calcium channel blocking agents have been shown to be beneficial in treatment of both rest and effort angina syndromes.1*2 Improvement occurs in patients with and without demonstrated coronary artery spasm. In a short-term controlled trial, patients presenting with rest angina and ST shifts showed significant reduction in angina frequency, nitroglycerin consumption, and episodes of ST segment shifts with verapamil compared to placebo.3 We found similar initial results in another placebocontrolled trials in patients with either ST depression or elevation presenting to the coronary care unit4 Although these experiences suggest that verapamil can reduce the frequency of rest angina associated with ST shifts, only short-term results have been reported. This apparent success in initial management of rest angina was achieved under conditions associated with hospitalization in the coronary care unit. It remains to be shown that continued treatment with verapamil on an ambulatory basis is an effective, safe, and practical therapeutic approach for this subset of patients with ischemic heart disease. Accordingly, the purpose of the current report was to evaluate effectiveness and safety of continued administration of verapamil in the ambulatory phase of treatment of patients with rest angina. The study was specifically designed to answer questions relative to therapeutic response, compliance, need for hospitalization, and other practical aspects of the ambulatory care of this subset of patients. We also felt that it was important to determine whether or not the short-term in-hospital response could be used to predict the long-term ambulatory response.