The use of propranolol and nifedipine in the medical management of angina pectoris.

This study investigates the use of propranolol and nifedipine in the treatment of angina pectoris. The clinical response and the effects on the precordial 16-lead electrocardiogram before and after exercise were studied in 52 patients with frequent angina pectoris. Relief of chest pain and abolition of exercise-induced ST-segment depression was achieved in 16 patients on treatment with propranolol alone (mean dose, 300 mg/d). Of the remaining 36 patients, the precordial area and severity of exercise-induced ST-segment depression were unchanged in 8 patients, of whom 2 reported they were free from chest pain, improved in 10 patients of whom 4 reported they were free of chest pain, and abolished in 14 patients, all of whom were free from chest pain following treatment with both propranolol and nifedipine (mean dose, 50 mg/d). Four patients were unable to tolerate this combination. This study has shown that in patients who do not respond to treatment with propranolol alone the combination of propranolol and nifedipine can be used to control not only anginal pain, but also the precordial electrocardiographic manifestations of ischemia.