Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The recurrence of coronary obstruction after initially successful percutaneous transluminal coronary angioplasty (PTCA) represents a major problem of this interventional procedure at present. In the pathogenesis of restenosis the growth factor-dependent proliferation and migration of medial smooth muscle cells into the intima of the vessel wall may play a very important role. In experimental studies this process could be inhibited by calcium antagonists. However, the first two placebo-controlled clinical trials showed disappointing results: the restenosis rate was not decreased by the treatment with 10 mg of nifedipine four times daily or by the treatment with 90 mg of diltiazem three times daily. The influence of high-dose verapamil treatment [Isoptin RR (240 mg) twice daily] on the recurrence of coronary stenosis has been investigated by a recently completed double-blind, placebo-controlled trial, the verapamil angioplasty study (VAS). The VAS included 196 consecutive patients with at least one risk factor for restenosis after successful PTCA for stable angina pectoris (n = 75) or unstable angina pectoris/non-Q-wave infarction (n = 97). Eighty-eight percent of the patients underwent follow-up angiography at 4.3 +/- 2.3 months. The publication of detailed data of the VAS including restenosis rates in both clinical subgroups is being prepared.
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PMID:Prevention of restenosis after PTCA: role of calcium antagonists. 172 11

The relatively short half life of verapamil necessitates divided daily dosing in the treatment of angina, hypertension and arrhythmia. To reduce dosing frequency and increase patient compliance and therapeutic efficacy, a controlled-release once-daily verapamil formulation (Verelan) has been developed in three dosage strengths, 120 mg, 240 mg and 360 mg. In order to investigate the dose linearity of this formulation in the 120 mg and 360 mg dose range, un unblinded, crossover, comparative evaluation of the three dosage strengths was performed in a population of 27 male volunteers. Each treatment period lasted nine days with a minimum of 7 days between periods. On Days 1 and 2 of each treatment period, the single dose phase was evaluated following administration of medication on Day 1 only with regular blood sampling over the 48 hour period. On Days 3 and 7 inclusive, the five-day steady phase was evaluated. Mean plasma profiles following administration of each dose demonstrated extended verapamil absorption up to 24 hours after dosing. In both the single dose and steady state phases a linear relationship was observed between increasing dose and pharmacokinetic response over the dose range of 120 mg and 360 mg. This linearity in response with increasing dose is in contrast to the non-linearity of verapamil's pharmacokinetics with conventional verapamil formulations previously described by an number of workers and may be due to a saturation of verapamil's hepatic first pass metabolic pathway.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Dose proportionality of pharmacokinetics with a cr-verapamil formulation. 182 Aug 98

In experimental studies the growth factor dependent proliferation and migration of medical smooth muscle cells was found to be inhibited by calcium-antagonists. Since this process seems to play an important role in the pathogenesis of recurrent stenosis, clinical trials were performed to evaluate the influence of calcium-channel blockers on restenosis rate after initially successful coronary angioplasty. However, according to the first 3 completed studies the restenosis rate was not decreased significantly either by the treatment with nifedipine or by the treatment with different dosages of diltiazem. The influence of high-dose verapamil treatment (Isoptin RR, 240 mg verapamil, twice daily) on the recurrence of coronary obstruction has been investigated by a recently completed prospective double-blind, placebo-controlled trial (VAS) which included 196 consecutive patients with at least one risk factor for restenosis. Patients with stable angina pectoris (n 75) and patients with unstable angina/non Q-wave infarction (n 97) were randomized separately. Follow-up angiography within 6 months after the procedure was performed in 88% of the recruited patients. Another 22 patients (11%) stopped the study medication before control angiography. At present, detailed data of the intention-to-treat analysis and the as-treated analysis of the results of VAS were submitted for publication.
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PMID:Calcium-antagonists in preventing restenosis following coronary angioplasty. 184 74

The efficacy and tolerability of sustained release verapamil (Securon SR) was investigated in twenty-four patients with chronic stable angina. Patients entered four randomised, double-blind treatment periods, each lasting one week of verapamil-SR 240 mg once daily, 360 mg once daily, 240 mg twice daily, and matching placebo. Four patients were withdrawn, but in one instance this was attributable to side effects from verapamil. Among the remaining twenty patients, mean frequency of angina fell from 4.25 episodes during the last five days of placebo to 2.35, 2.6 and 1.3 episodes during respective active treatments (all P less than 0.001). Compared with placebo the median percentage increase in time to 1 mV ST depression during treadmill exercise (12 hours post dose) was significant only with the regimen of verapamil-SR 240 mg given twice daily at +11% (P = 0.04). Total duration of exercise was also significantly longer and maximum ST depression significantly less only with the twice daily treatment (704 + 186 sec vs 648 + 203 sec; P = 0.03, and 1.75 + 0.73 mm vs 2.15 +/- 0.62 mm; P = 0.02). Side effects, predominantly constipation, breathlessness, and swollen ankles, occurred most frequently with verapamil-SR 360 mg. Thus, sustained release verapamil is well tolerated and effective in the treatment of angina. A regimen of 240 mg given twice daily emerges as superior to once daily treatments for 24-hour prophylaxis of angina.
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PMID:Double-blind randomised placebo-controlled dose-efficacy study of sustained release verapamil in chronic stable angina. 187 77

In the treatment of angina pectoris a double-blind evaluation of verapamil (Cordilox) at two dose levels-namely, 80 mg thrice daily and 120 mg thrice daily-propranolol (Inderal) 100 mg thrice daily, and isosorbide dinitrate (Vascardin) 20 mg thrice daily has been made against a placebo. The assessment was based on relief from daily attacks of angina on effort and the response to a whole-body exercise test. We can find no statistically significant difference between the effects of verapamil (120 mg three times a day) and propranolol (100 mg three times a day) in the treatment of angina of effort. Both of these preparations are more effective than a placebo both in the reduction of daily attacks (P < 0.01) and in the prolongation of exercise test (P < 0.05). Isosorbide dinitrate (20 mg three times a day) appears to be no more effective than a placebo in the treatment of angina on effort, but 14 out of 32 patients experienced headache of such severity that even when the dose was reduced to 10 mg thrice daily this drug therapy had to be withdrawn. Both propranolol (100 mg three times a day) and verapamil (120 mg three times a day) had a significant lowering effect on the diastolic blood pressure as measured with the patient standing (P < 0.01).
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PMID:Double-blind evaluation of verapamil, propranolol, and isosorbide dinitrate against a placebo in the treatment of angina pectoris. 457 Jun 71

Since Isoptin increases coronary blood flow in the dog and improves patients with angina pectoris, the drug was studied by coronary cineangiography (Sones' technique) to determine the degree of vasodilatation so produced. When Isoptin, 5 mg. in 2 ml. of solvent, was injected intravenously into five patients with coronary disease and five without coronary disease, there was no change in the size of the main coronary vessels or in the degree of impregnation of the heart muscle, and no new vessels appeared. Isoptin produced a constant decrease in systolic, diastolic and mean blood pressure and a constant increase in heart rate.The clinical improvement in patients taking the drug may be independent of coronary vasodilatation. The drug may act by antagonizing beta-adrenergic effects.
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PMID:Coronary cineangiographic study of intravenously administered isoptin. 595 91

1. In a double blind cross-over study the effect of verapamil (Isoptin) 360 mg/d and propranolol 180 mg/d was evaluated in patients with stable angina pectoris. The results of verapamil and propranolol treatment are compared to a single blind placebo period of 2 weeks. 2. Both verapamil and propranolol caused a significant reduction in glyceryl trinitrate tablet consumption, days with angina pectoris and in severe angina attacks compared to placebo. A 50% reduction in angina pectoris attacks and/or glyceryl trinitrate consumption compared to placebo was demonstrated in thirteen of eighteen patients during verapamil treatment (P less than 0.01) and in seven of seventeen patients during propranolol treatment (P greater than 0.05). Of sixteen patients accomplishing both treatment periods, ten improved both on verapamil and propranolol, three on verapamil only, one on propranolol only, one was unchanged and one deteriorated on verapamil and propranolol. During exercise, maximum exercise capacity was increased during verapamil compared to placebo (P less than 0.01) and propranolol (P less than 0.02). Maximum exercise capacity was not increased after propranolol compared to placebo. 3. These findings are in accordance with other reported series, and verapamil is at least as effective as propranolol in the treatment of angina pectoris.
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PMID:Verapamil and beta-adrenoceptor blockade in the treatment of stable angina pectoris. 612 87

In a double blind cross-over study the effect of verapamil (Isoptin) 360 mg/d and propranolol 180 mg/d was evaluated in patients with stable angina of effort. The results of verapamil and propranolol treatment were compared to a single blind placebo period of 2 weeks. Both verapamil and propranolol caused a significant reduction in nitroglycerin consumption, days with angina pectoris and in severe angina attacks as compared to placebo. A 50% reduction in angina pectoris attacks and/or nitroglycerin consumption compared to placebo was demonstrated in thirteen of eighteen patients during verapamil treatment (P less than 0.01) and in seven of seventeen patients during propranolol treatment (P greater than 0.05). Of sixteen patients completing both treatment periods, ten were improved both on verapamil and propranolol, three on verapamil only, one on propranolol only, one was unchanged and one deteriorated on verapamil and propranolol. During exercise, maximum exercise capacity was increased during verapamil as compared to placebo (P less than 0.01) and propranolol (P less than 0.02). Maximum exercise capacity was not increased after propranolol as compared to placebo. These findings, that verapamil is at least as effective as propranolol in the treatment of angina of effort, are in accordance with other reported series.
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PMID:Verapamil or propranolol in the treatment of stable angina pectoris of effort. 642 70

In 10 patients with stress stenocardia pharmacodynamics of Isoptin was studied with the aid of identical physical loads on the treadmill repeated with an hour's interval for 5-6 hours. A clearcut antianginal effect was recorded which consisted in the reduction of ST segment depression and of the pain syndrome for 5 hours after administration of 3 tablets over 5 hours and for 6 hrs 20 min after administration of 5 tablets of both drugs. The degree of effect increased considerably after the dose of isoptin was enhanced and was not changed after the dose of corinfar was enhanced. Difference in the haemodynamic effect of the drugs was found in their effect on the cardiac rate. Corinfar increased the cardiac rate, isoptin decreased it.
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PMID:[Calcium antagonists in stress angina pectoris (pharmacodynamic study)]. 715 4

Fixed verapamil SR/trandolapril combinations 180/1 mg and 180/2 mg (Tarka, Knoll AG) have a significantly superior antihypertensive effect compared to equal dosages of either agent alone. Verapamil SR/trandolapril 180/2 mg combination produces the best dose-response ratio of different dose combinations of these two drugs. Combination therapy has the most pronounced effect on blunting the early morning rise in blood pressure. Thus, verapamil SR/trandolapril combination therapy may be an appropriate treatment option in patients with moderate essential hypertension, particularly in those who have a tendency toward the early morning rise in blood pressure. The adverse effect profile of the fixed combination of verapamil SR/trandolapril includes the typical side effects of its monocompounds. The fixed combination of verapamil SR/trandolapril is also effective and safe in the treatment of hypertension in the elderly. The fixed low-dose combination therapy with verapamil SR/trandolapril 180/2 mg is a suitable treatment option for patients with moderate essential hypertension and Type 2 diabetes mellitus, because it improves parameters of carbohydrate metabolism and uricaemia and does not alter the lipid profile. The insulin-sensitising effect of angiotensin converting enzyme (ACE) inhibitor monotherapy with its theoretical risk of hypoglycaemia is completely neutralised in the combination with verapamil SR. Comparative studies have shown that the low-dose combination of verapamil SR/trandolapril may be a suitable alternative to combinations containing a thiazide diuretic or a beta-blocking agent for the long-term management of hypertensive patients for whom combination therapy is indicated. The combination of an ACE inhibitor with a non-dihydropyridine calcium channel blocker reduces proteinuria to a greater extent than either agent alone. A combination of an ACE inhibitor and a calcium channel blocker may provide additional benefit in inducing the regression of left ventricular hypertrophy. Combination therapy leads to a significant increase in left ventricular ejection fraction, improvement of wall motion index and increases exercise duration time in patients with coronary heart disease and left heart failure. It also improves the ratio of exercise to rest rate-pressure product and decreases the number of angina attacks. These findings support the hypothesis that the combination of verapamil and trandolapril might be useful in patients with attenuated left ventricular function and angina pectoris. Thus, Tarka is an effective and well-tolerated antihypertensive agent with a good safety profile and positive metabolic effects.
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PMID:The fixed combination of verapamil SR/trandolapril. 1124 35


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