Rationale for treatment of silent myocardial ischemia: focus on nifedipine.

The realization that the majority of ischemic episodes in ambulatory patients with coronary artery disease are not associated with angina has raised important questions regarding the medical management of such individuals. Data from studies utilizing ambulatory Holter monitoring of the ST segment suggest that ischemia is likely to be due to a combination of a modest rise in myocardial oxygen demand and a concomitant decrease in coronary perfusion. Patients with ambulatory ischemia may have a poorer survival than those without ischemia during daily activities. This paper will address the potential impact these new findings could have on treatment. A growing body of knowledge regarding the use of nifedipine for silent ischemia will be examined. Enthusiasm to make abolition of ischemia an end point of therapy in patients with coronary artery disease will necessitate a reexamination of drugs that have been assessed largely on their ability to provide symptomatic relief.