Document Detail

Effects of titrated beta blockade (metoprolol) on silent myocardial ischemia in ambulatory patients with coronary artery disease.
MedLine Citation:
PMID:  3630934     Owner:  NLM     Status:  MEDLINE    
This study investigates effects of beta-adrenergic blockade on total silent ischemic time assessed by ambulatory electrocardiographic monitoring and its relation to heart rate and time of day in ambulatory men with coronary artery disease. Metoprolol, when titrated to optimal dose in a controlled trial in 9 patients, reduced both total silent ischemic time (from 156 +/- 65 to 20 +/- 15 minutes, p = 0.04) and frequency of silent ischemic episodes (from 8 +/- 2 to 2 +/- 2 episodes, p = 0.03) compared with placebo. Mean daily heart rate was reduced, from 82 +/- 2 beats/min during placebo to 58 +/- 1 beats/min, as was heart rate at onset of 1 mm of ST-segment depression (106 +/- 2 to 74 +/- 4 beats/min, both p less than 0.001). Heart rate increased 10 +/- 1 beats/min during silent ischemia with placebo therapy, but increased only 4 +/- 1 beats/min during metoprolol treatment (p less than 0.03). During placebo administration the largest proportion of silent ischemic time occurred between 0600 and 1200 hours. Metoprolol attenuated this circadian variation in silent ischemia while reducing (p less than 0.05) total silent ischemic time in all periods. Thus, beta-adrenergic blockade reduces the frequency of silent myocardial ischemic episodes and total silent ischemic time, while mean daily heart rate and heart rate at onset of ischemia and maximal ischemia decrease. Metoprolol treatment also attenuates circadian variation of silent ischemia. These data may be interpreted to suggest that beta-adrenergic activation operates in the pathogenesis of silent myocardial ischemia and its circadian variation.
G A Imperi; C R Lambert; K Coy; L Lopez; C J Pepine
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  60     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1987 Sep 
Date Detail:
Created Date:  1987-10-19     Completed Date:  1987-10-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  519-24     Citation Subset:  AIM; IM    
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MeSH Terms
Circadian Rhythm / drug effects
Coronary Disease / drug therapy*,  physiopathology
Double-Blind Method
Heart Rate / drug effects
Metoprolol / therapeutic use*
Monitoring, Physiologic
Random Allocation
Time Factors
Reg. No./Substance:
0/Placebos; 37350-58-6/Metoprolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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