Document Detail


The effect of an angiotensin-converting enzyme inhibitor and a K+(ATP) channel opener on warm up angina.
MedLine Citation:
PMID:  15618027     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: In various models, angiotensin-converting enzyme (ACE) inhibitors and K+(ATP) channel openers can potentiate and mimic ischaemic preconditioning, respectively. Our aim was to determine whether these characteristics are shared by the phenomenon of warm up in angina, often regarded as a surrogate of ischaemic preconditioning. METHODS AND RESULTS: Twenty patients with ischaemic heart disease were assigned in a double blind, randomized cross-over design to equivalent pressor doses of nicorandil 20 mg bid, enalapril 10 mg bid, losartan 25 mg bid, or placebo for 3 days. Patients underwent three consecutive exercise tolerance tests on each medication separated by a 1-week interval. Each patient underwent 12 exercise tests in total and 13 patients completed the study. On each medication the second exercise was separated from the first by 15 min of rest and the third exercise was performed 90 min after the second to control for training. The time to 0.1 mV ST depression and rate pressure product at 0.1 mV ST depression increased significantly in all groups during exercise two compared with exercise one. Nicorandil reduced angina but did not attenuate this warm up effect. This benefit of first exercise waned by test three with placebo, losartan, and nicorandil, but not with enalapril. CONCLUSION: In contrast to predictions based on ischaemic preconditioning the magnitude of the warm up was apparently unaltered by nicorandil, losartan, or enalapril, however its duration seemed to be extended by enalapril. Thus ischaemic preconditioning and warm up angina are likely to have differing pharmacological profiles suggesting a diverse underlying mechanism.
Authors:
Richard J Edwards; Simon R Redwood; Pier D Lambiase; Michael S Marber
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2004-12-20
Journal Detail:
Title:  European heart journal     Volume:  26     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-01     Completed Date:  2005-06-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  598-606     Citation Subset:  IM    
Affiliation:
Division of Cardiology, KCL, The Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK.
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MeSH Terms
Descriptor/Qualifier:
Adaptation, Physiological
Angina Pectoris / etiology
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Cross-Over Studies
Double-Blind Method
Electrocardiography
Enalapril / therapeutic use*
Exercise Test
Female
Humans
Ischemic Preconditioning, Myocardial
Losartan / therapeutic use
Male
Middle Aged
Myocardial Ischemia / drug therapy*,  physiopathology
Nicorandil / therapeutic use*
Potassium Channels / drug effects*
Receptors, Angiotensin / antagonists & inhibitors
Regression Analysis
Vasodilator Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Potassium Channels; 0/Receptors, Angiotensin; 0/Vasodilator Agents; 114798-26-4/Losartan; 65141-46-0/Nicorandil; 75847-73-3/Enalapril

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


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