Antianginal efficacy and improved exercise performance with timolol. Twice-daily beta blockade in ischemic heart disease

Fred J. Harris, Reginald Low, Linda Paumer, Ezra A Amsterdam, Dean T. Mason

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Antianginal efficacy and improved exercise performance with timolol, a new beta-adrenergic blocking agent, was assessed in 23 patients with chronic stable angina pectoris in an 11-week double-blind, placebo-controlled study. Twenty-two of the 23 subjects completed the open-label phase of this investigation (weeks 0 to 6) while receiving 10 to 30 mg of timolol twice daily to optimize exercise capacity. Weekly anginal episodes and nitroglycerin consumption declined from 8.9 ± 9.1 episodes/week and 8.1 ± 10.6 tablets/week, respectively, with placebo to 2.7 ± 5.2 episodes/week and 2.6 ± 6.0 tablets/week with optimal timolol dose (p <0.05). Resting heart rate (HR) and systolic blood pressure (SBP) also decreased from 75.2 ± 14.0 beats/min and 139.1 ± 15.7 mm Hg with placebo to 55.1 ± 8.9 beats/min and 130.5 ± 15.9 mm Hg with timolol (p <0.05). Peak exercise HR, peak exercise SBP, and peak exercise double product (HR × SBP) were significantly (p <0.05) reduced when evaluated 12 to 13 hours after administration of timolol compared with placebo (101.5 ± 21.1 beats/min versus 193.3 ± 96.2 beats/min, 161.5 ± 26.7 mm Hg versus 175.6 + 20.8 mm Hg, and 16.6 ± 5.1 × 10-3 versus 21.7 ± 5.4 × 10-3, respectively). Exercise duration was prolonged from 263.3 ± 90.2 seconds to 330.3 ± 73.9 seconds (p <0.05), while time to onset of 1 mm S-T segment depression was delayed in 15 patients from 231.8 ± 86.4 seconds to 298.7 ± 68.4 seconds (p <0.05). During the double-blind phase (weeks 7 to 10), 8 subjects received timolol and 11 patients received placebo. Nitroglycerin consumption at weeks 8 and 10 and anginal frequency at week 8 were unchanged compared with initial placebo treatment. Resting HR, peak exercise HR, and peak exercise double product were significantly attenuated at weeks 8 and 10 in timolol patients compared with their initial placebo exposure. However, these variables were unchanged in placebo subjects compared with their initial placebo therapy. Exercise duration was again prolonged at week 8 in timolol subjects compared with initial placebo results (315.1 ± 61.2 seconds versus 261.3 ± 68.8 seconds, p <0.05), but not at week 10. Placebo patients demonstrated no difference at week 8 or 10 in exercise performance compared with initial placebo treatment. Timolol twice daily, therefore, is potentially useful in some patients with angina pectoris. Other patients may, however, require a shorter dose interval for optimal angina control and maximal improvement in exercise capacity.

Original languageEnglish (US)
Pages (from-to)13-18
Number of pages6
JournalThe American journal of cardiology
Volume51
Issue number1
DOIs
StatePublished - Jan 1 1983

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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