Isosorbide-5-mononitrate and nifedipine can reduce ischaemic ST-segment changes during Holter monitoring in patients with spontaneous angina pectoris.

Ambulatory electrocardiographic monitoring is as yet the only method to document ischaemia occurring in patients with coronary artery disease during their normal daily activities. We conducted a controlled double-blind trial comparing the effects of isosorbide-5-mononitrate (IS-5-MN) 3 X 20 mg, sustained release IS-5-MN 50 mg once daily and sustained release nifedipine 3 X 20 mg in patients with documented coronary heart disease and transient ischaemic episodes. 20 patients were included, 15 finished the four-week study period. Two developed unstable angina, one headache, one thyreotoxicosis, one a hypertensive crisis and were thus withdrawn. On dual-channel FM recorded ECG ischaemic episodes were counted when ST-deviation was more than 1 mm for more than 1 min. 70% of the ischaemic episodes were asymptomatic. Patients received IS-5-MN and nifedipine in 4 weekly periods in random order. At the end of each weekly period, ambulatory monitoring was repeated and showed reduction of episodes by 68% and 68% for IS-5-MN weeks and 56% and 60% for nifedipine weeks all P less than 0.05 vs. pretreatment. The reduction in number and duration of episodes was similar for painful and painless episodes. Individual responses were very variable and in all treatment periods only around half of the patients became completely free of ischaemic episodes. Two of the 15 patients did not respond to either way of treatment. In conclusion--treatment effects for a group of patients with transient--predominantly silent--ischaemia can be documented with ambulatory electrocardiographic monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

RCT Entities:   Population Interventions Outcomes