Dilitiazem Therapy in Stable Angina Petoris: A Placebo-Controlled Study

The antianginal and metabolic effets of dilitiazem were investigated in 18 patients (5 female, 13 male, mean age 53.0±1.7) with stable angina pectoris during 2 weeks of placebo and 4 weeks of diltiazem (180-360 mg/day) trial periods. The patients performed a symptom-limited supine bicycle exercise test at the beginning of the study and at the end of the placebo and diltiazem periods. The frequency of angina and consumption of sublingual nitrates were decreased significantly by diltiazem (p<0.001, diltiazem vs placebo). Mean exercise time, time to onset of angin pectoris and 1 mm ST segment depression of placebo period were increased at the end of the diltiazem therapy (all p<0.001). Heart rate and myocardial oxygen demand as indicated by rate-pressure product were decreased by diltiazem at rest (both p<0.001) and at a submaximal workload (p<0.01) and p<0.02, respectively), but remained unchanged at the level of peak exercise (p>x0.05 for both) when compared to placebo. ST segment depression at submaximal and peak exercise and ST segment recovery time after completion of exertion were reduced significantly by diltiazem treatment (p<0.001). In addition no significant changes in plasma total cholesterol, triglyceride, ALT, AST, uric acid, glucose and creatinine levels were observed after 4 weeks of diltiazem treatment. We coulld not detect any serious side effects. These findings confirm that diltiazem is an effective antianginal agent lacking undesirable side effects and can be used safely in the management of patients with chronic stable angina pectoris wh have no congestive heart failure or serious conduction defects.