Document Detail

Rationale for the use of calcium antagonists in the treatment of silent myocardial ischemia.
MedLine Citation:
PMID:  9385506     Owner:  NLM     Status:  MEDLINE    
Silent myocardial ischemia, whether it occurs at rest or during exercise, is associated with an unfavorable prognosis and may lead to sudden cardiac death. Agents used to treat silent myocardial ischemia have included nitrates, beta-blockers, and calcium antagonists (CAs). Despite treatment with traditional anti-ischemic agents, studies have shown that up to 40% of patients who receive what is considered to be clinically optimal antianginal therapy continue to have daily episodes of silent myocardial ischemia. The use of nitrates and beta-blockers is sometimes confounded by issues of tolerance and tolerability. Although the CAs have been found to be effective in decreasing the duration and frequency of episodes of silent ischemia, in general beta-blockers produce a greater reduction in these variables. Thus a need for effective and tolerable anti-ischemic agents persists. A new class of CAs, the tetralol derivatives, may show promise in this regard. The first of this new class, mibefradil, is characterized by selective blockade of T-type calcium-ion channels and has been shown in a few studies to reduce the frequency and duration of asymptomatic ischemic episodes in patients with stable exertional angina pectoris. Large-scale clinical trials are necessary before the efficacy and tolerability of this new CA can be compared fully with those of the beta-blockers and currently available CAs.
P F Cohn
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Clinical therapeutics     Volume:  19 Suppl A     ISSN:  0149-2918     ISO Abbreviation:  Clin Ther     Publication Date:  1997  
Date Detail:
Created Date:  1998-01-15     Completed Date:  1998-01-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7706726     Medline TA:  Clin Ther     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  74-91     Citation Subset:  IM    
Department of Medicine, State University of New York Health Sciences Center, Stony Brook, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Blood Pressure
Calcium Channel Blockers / therapeutic use*
Clinical Trials as Topic
Drug Therapy, Combination
Heart Rate
Myocardial Ischemia / drug therapy*,  physiopathology
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Calcium Channel Blockers

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