A COMPARISON OF NISOLDIPINE AND NIFEDIPINE, IN COMBINATION WITH ATENOLOL, IN THE MANAGEMENT OF MYOCARDIAL-ISCHEMIA

The effects of the addition of slow-release nifedipine 20 mg twice daily and nisoldipine 10 mg twice daily to atenolol monotherapy were compared in a double-blind placebo-controlled study of 24 patients with chronic stable angina pectoris. Neither nisoldipine nor nifedipine was associated with significant subjective benefit at these doses. Two hours post-dosing, exercise capacity improved after both nisoldipine (duration+37 s, P<0.01; time to angina+67 s, P<0.01; time to sign ST depression+60 s, P<0.01) and nifedipine (duration +21 s, ns; time to angina+56 s, P<0.05; time to significant ST depression+49 s P<0.05) However, this improvement was not maintained 12 h post-dosing. Ambulatory monitoring did not demonstrate a sign reduction in the amount of silent or total ischaemia following the addition of either nifedipine or nisoldipine to atenolol monotherapy. There was no significant difference between nifedipine and nisoldipine in any parameter tested.In conclusion, like slow-release n 20 mg, the effective duration of anti-ischaemic action of nisoldipine 10 mg is less than 12 h. Since several patients experienced vasodilatory unwanted effects, more frequent administration rather than larger individual doses may be desirable to achieve a clinical response. © 1993 The European Society of Cardiology.