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Tamar T. Kikalishvili, Vakhtang B. Chumburidze, Ramaz B. Kurashvili, Maia N. Khelashvili, Merab A. Kvitashvili, P-459: Exercise-induced and silent ischemia: Different effects of monotherapy, American Journal of Hypertension, Volume 14, Issue S1, April 2001, Page 185A, https://doi.org/10.1016/S0895-7061(01)01639-9
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Abstract
The study was performed to compare the effects of lacidipine, bisoprolol and trimetazidine on ischemia during exercise-testing and 24-hour ECG monitoring. Sixty patients with stable coronary artery disease, positive exercise tests and at least two transient ischemic episodes during 24-hour Holter monitoring were randomized to receive lacidipine (n=20; 4 mg), bisoprolol (n=20; 10 mg) and trimetazidine (n=20; 60 mg) for 8 weeks subsequent to a 2-week placebo phase. All drugs increased exercise tolerance in terms of its duration (29% with lacidipine, 20% with bisoprolol and 24% with trimetazidine), time to onset of 1 mm ST-depression (23% with lacidipine, 18% with bisoprolol and 19% with trimetazidine) and reduced maximal ST-segment depression (30% with lacidipine, 20% with bisoprolol and 25% with trimetazidine). (p<0.001 vs placebo). The between group difference was sagnificant only in case of lacidipine vs bisoprolol (p<0.05). Data obtained with 24-hour Holter monitoring revealed that the mean number of ischemic episodes/24-hours in all treatment groups decreased (56% with bisoprolol; 29% with lacidipine and 27% with trimetazidine). The between group differense was significant in case of bisoprolol vs lacidipine and trimetazidine. 1. Lacidipine and trimetazidine were the best in suppressing the excertional ischemia. 2. Bisoprolol was the best in suppressing ischemia during daily activity. Average heart rate was slightly increased with lacidipine (NS), unchanged with trimetazidine and decreased with bisoprolol. 3. Lacidipine and bisoprolol reduced the early morning peak and lowered the afternoon peak of transient ischemic episodes. Trimetazidine led only to a reduction of the late afternoon peak of transient ischemic episodes. All drugs left the circadian distribution of ischemic episodes unchanged.
