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)

This study was designed to compare once-daily administration of 5-10 mg amlodipine with two daily doses of 40 mg sustained-release isosorbide dinitrate in 59 patients with stable angina using a randomized, double-blind, crossover study design. Anginal episodes, nitroglycerin consumption, and possible adverse events were recorded in a diary. A maximal symptom-limited bicycle exercise test and 48-hour ambulatory ECG monitoring were performed at baseline and at the end of each 5-week period of therapy. Exercise time, time to angina, time to ST depression, and maximal ST depression were measured during exercise. During ambulatory monitoring, the number of ischemic episodes and the duration per hour of ST depression were assessed. Amlodipine significantly reduced anginal episodes (P < 0.001) when compared with isosorbide dinitrate. Furthermore, amlodipine prolonged time to ST depression (P < 0.001) and time to angina (P < 0.05) when compared with isosorbide dinitrate. The number and duration of ischemic episodes during ambulatory monitoring were significantly reduced with amlodipine when compared with baseline values (P < 0.05), whereas no differences were found between isosorbide dinitrate and baseline. Adverse events were reported more frequently with isosorbide dinitrate than with amlodipine (P < 0.02). Amlodipine appears to be more effective and tolerable than sustained-release isosorbide dinitrate as monotherapy for chronic stable angina.
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PMID:Effects of amlodipine and isosorbide dinitrate on exercise-induced and ambulatory ischemia in patients with chronic stable angina pectoris. 949

Recent trials in hypertensive patients with type 2 diabetes reveal important differences in the risk for major cardiovascular events when individual agents are compared. In the Fosinopril Amlodipine Cardiovascular Events Trial (FACET), 380 patients with hypertension and type 2 diabetes were randomized to fosinopril or amlodipine and followed for up to 3.5 years to assess effects on serum lipids. Although both agents effectively controlled blood pressure, amlodipine caused a significantly greater decrease in systolic pressure. At the end of the trial, serum cholesterol, high-density lipoprotein cholesterol, triglycerides, HbA1c, serum glucose, plasma insulin, serum creatinine, and microalbuminuria were similar in both groups. The patients randomized to fosinopril were significantly less likely to experience the prospectively defined combined outcome of acute myocardial infarction (MI), hospitalized angina, or stroke compared to those randomized to amlodipine (RR 0.49; 95% CI 0.26-0.95). In the Appropriate Blood pressure Control in Diabetes (ABCD) trial, 470 patients with hypertension and type 2 diabetes who were randomized to long-acting nisoldipine had an adjusted sevenfold increased risk for acute MI compared to those randomized to enalapril (RR 7.0; 95% CI 2.3-21.4). In the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS) trial, the patients with hypertension and above the median of HbA1c (> or =6.7%) randomized to isradipine had a threefold increased risk for major cardiovascular events compared to those randomized to hydrochlorothiazide (RR 2.81; 95% CI 1.09-7.26). These findings are supported by several observational studies. Therefore, evidence is emerging that angiotensin-converting enzyme inhibitors and low-dose diuretics may be more effective than calcium antagonists for prevention of cardiovascular events in hypertensive patients with diabetes or impaired glucose control.
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PMID:New evidence on the prevention of cardiovascular events in hypertensive patients with type 2 diabetes. 973 37

A multicenter, double-blind study was performed to compare the efficacy and safety of the calcium antagonists, amlodipine and diltiazem controlled release (CR), in patients with stable angina pectoris. One hundred and thirty-two patients were randomized to receive either amlodipine (5-10 mg) once daily or diltiazem CR (90-120 mg) twice daily for 8 weeks. A standard bicycle exercise tolerance test was used for the primary efficacy assessment. The median time to 1 mm ST-segment depression and time to onset of chest pain were increased by 16% (P < 0.0001) and 13% (P < 0.0001) with amlodipine, and by 16% (P < 0.0001) and 7% (P = 0.009) with diltiazem CR, respectively. Amlodipine, but not diltiazem CR, also produced a significant improvement in the median time to end of exercise of 5% (P < 0.0002), although the between-treatment difference for this parameter was not statistically significant. The number of angina attacks and nitroglycerin (NTG) tablet consumption were similar with both agents. Amlodipine was withdrawn in 3% and diltiazem CR in 9% of patients due to adverse events. The adverse events were reported by 15% of patients on amlodipine and 26% of those on diltiazem CR. The results from this study demonstrate that both drugs have a comparable therapeutic effect and possibly that amlodipine was better tolerated in patients with stable angina. Furthermore, amlodipine has the advantage of once-daily dosing and so may also be beneficial in ensuring good patient compliance.
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PMID:A comparative study of once-daily amlodipine versus twice-daily diltiazem controlled release (CR) in the treatment of stable angina pectoris. Amlodipine Study Group. 980 52

The Coronary AngioPlasty Amlodipine REStenosis Study (CAPARES) is a multicentre, double-blind, placebo controlled restenosis trial investigating the effect of amlodipine on angiographic and clinical endpoints in patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA) for stable angina pectoris. A total of 635 patients were randomized to amlodipine or placebo two weeks before PTCA and were followed for four months after PTCA. There were 451 nonstented patients who completed the study with angiographic follow-up. Quantitative coronary angiography revealed that the loss in minimal luminal diameter from immediately after PTCA to the four-month follow-up was unaffected by amlodipine treatment. However, the incidence of repeat PTCA and composite clinical events were significantly lower in patients treated with amlodipine.
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PMID:Results and clinical implications of the CAPARES trial. 1093 30

The purpose of the present study was to investigate whether treatment of male rats with the calcium antagonist amlodipine, used in the treatment of hypertension and angina, interferes with the reproductive function of male rats. Amlodipine treatment (0.04 mg amlodipine besylate/rat/day for 30 days) decreased plasma follicle-stimulating hormone and testosterone but not luteinizing hormone or prolactin concentrations (measured by double-antibody radioimmuno-assay). A significant reduction (23%) was observed in sperm density (sperm suspension collected from the cauda epididymidis) as well as in the amount of mature spermatids (14%) and Sertoli cells (9%) counted in seminiferous tubule cross-sections (400 x magnification). The results reveal the deleterious effects of subacute amlodipine treatment on the reproductive function of male rats.
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PMID:Antireproductive effect of the calcium channel blocker amlodipine in male rats. 1098 90

Overall, eighteen male patients with ischemic heart disease (IHD) and functional class II and III angina concurrent with stage II hypertensive disease were studied for clinical effectiveness of amlodipine (Norvasc), a new calcium antagonist, versus nifedipine and placebo. It has been ascertained that amlodipine (10 mg/day) had a significant antianginal and anti-ischemic effect and antihypertensive activity throughout 24 hours as well whereas nifedipine was effective for 6 to 8 hours. Amlodipine did not affect the well-being of the examined patients.
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PMID:[The clinical efficacy of the calcium antagonist amlodipine in patients with ischemic heart disease and arterial hypertension]. 1103 70

In 2002, the World Health Organization estimated that over 58% of cardiovascular disease in North America is due to 'both blood pressure and cholesterol higher than optimal'. Unfortunately, less than a third of patients with both conditions are identified, and fewer than one in ten reach the treatment goals for both factors. Adherence to treatment is notably improved when therapy is initiated simultaneously. Combination therapy of amlodipine besylate (Norvasc, Pfizer Ltd) with atorvastatin calcium (Lipitor, Pfizer Ltd), marketed as Caduet (Pfizer Ltd) is the first dual-therapy compound designed to treat hypertension and/or angina and dyslipidemia concurrently with a single daily pill in the full range of dosing combinations. Amlodipine/atorvastatin retains the safety and efficacy of its parent compounds whilst simplifying the management of these comorbid conditions, in what may be considered the first version of a polypill.
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PMID:Amlodipine/atorvastatin: the first cross risk factor polypill for the prevention and treatment of cardiovascular disease. 1535 Jan 69

The antianginal effects of lercanidipine, a newly synthesized 1,4-dihydropyridine derivative calcium channel antagonist, were evaluated in experimental angina model rats and the effects were compared with those of nifedipine, benidipine and amlodipine. In the vasopressin-induced angina model, intravenous administration of lercanidipine dose-dependently suppressed vasopressin-induced ST-depression. Amlodipine barely suppressed it, while benidipine, at the same dose, completely suppressed it. Nifedipine had a potency between that of amlodipine and benidipine. Oral administration of lercanidipine showed similar effects to the intravenous administration test on ST change. High doses of amlodipine, benidipine and nifedipine suppressed ST-depression by almost 100%. In the methacholine-induced angina model, lercanidipine suppressed the ST elevation dose dependently. Amlodipine barely suppressed it, while benidipine at 30 microg/kg effected almost total suppression. Nifedipine had a potency between that of amlodipine and benidipine. Intraduodenal administration of lercanidipine also suppressed the ST-elevation dose dependently. Nifedipine, benidipine and amlodipine at 10 mg/kg all markedly suppressed the elevation. Lercanidipine was more potent than the other calcium channel antagonists tested. In conclusion, it was explicitly demonstrated that lercanidipine exerts potent protective effects on the ischemic electrocardiography (ECG) changes in a variety of putative angina pectoris models in rats. An antispasmolytic coronary vasodilating action may be involved in the mechanism. It is expected that lercanidipine will be useful as an antianginal agent.
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PMID:Antianginal effects of lercanidipine on the vasopressin or methacholine induced anginal model in rats. 1586 84

Calcium channel blockers are used in the treatment of hypertension and angina. The negative findings on cardiovascular outcomes with some short-acting formulations of calcium channel blockers, described in the 1990s, have led to a much reduced use of calcium channel blockers in general. A Coronary disease Trial Investigating Outcome with Nifedipine (ACTION) investigated the effects of the long-acting gastrointestinal therapeutic system (GITS) formulation of nifedipine in patients with stable symptomatic coronary artery disease. There was less new overt heart failure in the nifedipine GITS group (117 of 3825 patients) than in the placebo group (158 of 3840), and coronary angiography and coronary bypass surgery were also lower in the nifedipine GITS than placebo group. Peripheral revascularisation was slightly higher in the nifedipine GITS (187/3825) than the placebo group (144/3840). The Comparison of Amlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) trial compared a calcium channel blocker (amlodipine) and angiotensin-converting enzyme inhibitor (enalapril) in normotensive patients with coronary artery disease. The primary outcome of cardiovascular events occurred in 151 (23.1%), 110 (16.6%) and 136 (20.2%) of placebo, amlodipine and enalapril patients, respectively, with the only significant difference being a reduction with amlodipine compared with placebo. This reduction mainly represented a reduction in coronary revascularisation and hospitalisation for angina with amlodipine compared with placebo. These results suggest that calcium channel blockers are safe and beneficial in the treatment of coronary artery disease.
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PMID:Has the controversy over the use of calcium channel blockers in coronary artery disease been resolved? 1593 8

Coronary vasospasm is an important pathophysiologic mechanism of angina at rest. Because the calcium antagonists are potent vasodilators, they have become widely used and are now considered the treatment of choice for vasospastic angina. Practically all currently available calcium antagonists in the United States have been shown to be efficacious and safe for the therapy of vasospastic angina. However, because spontaneous remissions are common and angina attacks can frequently occur during the nighttime, considerations such as the duration of action of a given agent, the duration of treatment, and patient compliance have become important in the selection of the most appropriate therapy. Amlodipine is a long-acting dihydropyridine derivative that is suitable for use as a once-daily calcium antagonist. There is preliminary evidence that amlodipine is efficacious and well tolerated in vasospastic angina. Amlodipine, therefore, has the potential to become the preferred calcium antagonist for this condition.
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PMID:The calcium antagonists in vasospastic angina. 1629 7


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