| Does the exercise protocol matter when assessing the anti-anginal effects of drug therapy? | |
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MedLine Citation:
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PMID: 8682006 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Four exercise test protocols (Bruce, Balke, Ellestad and Steep) were compared in 16 patients with proven coronary artery disease in demonstrating the anti-anginal effects of sublingual glyceryl trinitrate in a randomization double-blind trial. Glyceryl trinitrate significantly improved the time, heart rate and rate pressure product to peak exercise, onset of angina and 1 mm ST segment depression in all four protocols (P < 0.05) (except rate pressure product to angina in the Balke protocol). The increase in exercise time was greatest for the Balke protocol at peak exercise (188.1 +/- 187.1) (mean +/- SD in s), at onset of angina (251.9 +/- 247.1) and at 1 mm ST depression (233.6 +/- 243.8), followed by the Steep and Bruce protocols, and was lowest for the Ellestad protocol 41.9 +/- 42.4, 96.5 +/- 65.8, 82.6 +/- 74.0, respectively. Increase in time to peak exercise with glyceryl trinitrate was significantly greater for the Balke protocol in comparison with the other three protocols and for the Bruce and Steep protocols when compared to the Ellestad protocol. Time to 1 mm ST depression with treatment was significantly greater on the Balke and Bruce protocols than the Ellestad protocol, and to onset of angina for the Balke compared to other three protocols. There were no significant differences between the Bruce and Steep protocols for any of the endpoints. The magnitude of treatment effect in the different protocols was accompanied by correspondingly greater inter-patient variability such that no protocol was more, or less, sensitive than another in detecting treatment effect. Changes in heart rate and rate pressure product with treatment were generally similar between the different protocols. In conclusion, a protocol with small and frequent increments (Balke), although able to show greater increase in exercise duration with glyceryl trinitrate than more aggressive protocols, is no more sensitive at detecting treatment effect. |
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Authors:
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D J Patel; D Mulcahy; J Norrie; J Sparrow; C Wright; I Ford; K M Fox |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: European heart journal Volume: 16 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 1995 Dec |
Date Detail:
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Created Date: 1996-08-16 Completed Date: 1996-08-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 1773-9 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Royal Brompton Hospital, London, U.K. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angina Pectoris / drug therapy*, physiopathology Coronary Circulation / drug effects, physiology Coronary Disease / drug therapy*, physiopathology Double-Blind Method Electrocardiography / drug effects Exercise Test / methods* Humans Male Middle Aged Nitroglycerin / therapeutic use* Treatment Outcome Vasodilator Agents / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Vasodilator Agents; 55-63-0/Nitroglycerin |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 1995 Dec;16(12):1757-9
[PMID:
8682002
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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