Randomised, double-blind trial of intravenous diltiazem versus glyceryl trinitrate for unstable angina pectoris

Autor:	M. J. L. Dejongste, Raymond W.M. Hautvast, Hans L. Hillege, E.J.A.M. Göbel, W. H. Van Gilst, Kong I. Lie, G.P. Molhoek, J.N. Spanjaard
Rok vydání:	1995
Předmět:	Adult Male MYOCARDIAL-ISCHEMIA medicine.medical_specialty Analgesic Myocardial Infarction PROPRANOLOL Blood Pressure Propranolol REFRACTORY ANGINA NIFEDIPINE THERAPY Angina Diltiazem Double-Blind Method Nifedipine Heart Rate Internal medicine medicine Humans Angina Unstable cardiovascular diseases Myocardial infarction Infusions Intravenous Aged Aged 80 and over Unstable angina business.industry REST General Medicine Middle Aged Calcium Channel Blockers EFFICACY medicine.disease NITROGLYCERIN Relative risk Anesthesia cardiovascular system Cardiology Female business medicine.drug
Zdroj:	LANCET, 346(8991-2), 1653-1657. ELSEVIER SCIENCE INC
ISSN:	0140-6736
DOI:	10.1016/s0140-6736(95)92837-5
Popis:	The effect of dihydropyridines in patients with unstable angina is discouraging. To find out the effect of the non-dihydropyridine-like calcium-channel blocker diltiazem, a randomised, double-blind trial was conducted comparing diltiazem with glyceryl trinitrate, both given intravenously, in 129 patients with unstable angina. The endpoints were refractory angina or myocardial infarction, individually and as a composite endpoint. Refractory angina alone or together with myocardial infarction occurred significantly less commonly in the diltiazem group. While patients were on the trial drugs the numbers with refractory angina were 6 (10%) in the diltiazem group versus 17 (28%) in the glyceryl trinitrate group (relative risk 0.36, p = 0.02), and the numbers with refractory angina and myocardial infarction were 9 (15%) versus 23 (38%) (relative risk 0.40, p = 0.007). Over 48 h the number were: refractory angina 8 (13%) versus 18 (30%), relative risk 0.45, p = 0.03, and refractory angina and myocardial infarction 12 (20.0%) versus 25 (41%), relative risk 0.49, p = 0.02. Patients in the diltiazem group had better (p < 0.05) event-free survival while taking the drugs. Heart-rate pressure product was reduced significantly only by diltiazem (p < 0.05). The incidence of bradyarrhythmias did not differ significantly. Atrioventricular conduction disturbances occurred in 5 (8%) patients in the diltiazem group but were not seen in the glyceryl trinitrate group (p = 0.03). These disturbances could be reversed by decreasing the dose of the drug or withdrawing it. No temporary pacemakers were required. Headache requiring an analgesic or dose adjustment occurred significantly less in the diltiazem group: 3 (5%) versus 15 (25%), relative risk 0.20 (p < 0.004). These results indicate that intravenous diltiazem, compared with intravenous glyceryl trinitrate, significantly reduces ischaemic events and can be used safely in patients with unstable angina.
Databáze:	OpenAIRE
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