Efficacy of beta adrenergic blockade in coronary heart disease

Propranolol in angina pectoris

Richard R. Miller, Harold G. Olson, Craig M. Pratt, Ezra A Amsterdam, Dean T. Mason

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Despite widespread clinical application of propranolol (P) in angina pectoris, convincing evidence of its efficacy has been incomplete, thereby resulting in continued controversy. Its antianginal effectiveness was investigated in 20 patients with documented coronary heart disease in a 44-wk study incorporating a prolonged 12-wk lead-in period, individualization of P dosage in a 6-wk dose-finding period, and a 24-wk double-blind crossover phase. On double-blind placebo, patients had 10.5 ± 2.1 anginal attacks and consumed 12.8 ± 3.0 nitroglycerin tablets (NTG) each week compared to 6.6 ± 1.5 anginal episodes (-37%, p < 0.001) and 8.0 ± 1.7 NTG (-38%, p < 0.001) when on P. No patient experienced more angina with P than with placebo. In addition, time to onset of chest pain during treadmill exercise was prolonged by P from 190 ± 16 to 248 ± 22 sec (+31 %, p < 0.02) and ST depression was reduced from 1.7 ± 0.21 to 0.99 ± 0.18 mm (-42%, p < 0.05). There was correlation (r = 0.64, p < 0.01) between per cent declines in anginal frequency and resting double product with P. Thus, propranolol favorably altered several indices of myocardial ischemia in severe coronary heart disease. This investigation clearly documents the clinical efficacy of optimal beta adrenergic blockade in coronary disease and provides objective justification for the judicious application of propranolol in treatment of angina pectoris.

Original languageEnglish (US)
Pages (from-to)598-605
Number of pages8
JournalClinical Pharmacology and Therapeutics
Volume18
Issue number5 PART 1
StatePublished - Nov 1975

Fingerprint

Angina Pectoris
Propranolol
Adrenergic Agents
Coronary Disease
Nitroglycerin
Tablets
Placebos
Chest Pain
Myocardial Ischemia
Exercise
Therapeutics

ASJC Scopus subject areas

  • Pharmacology

Cite this

Efficacy of beta adrenergic blockade in coronary heart disease : Propranolol in angina pectoris. / Miller, Richard R.; Olson, Harold G.; Pratt, Craig M.; Amsterdam, Ezra A; Mason, Dean T.

In: Clinical Pharmacology and Therapeutics, Vol. 18, No. 5 PART 1, 11.1975, p. 598-605.

Research output: Contribution to journalArticle

Miller, Richard R. ; Olson, Harold G. ; Pratt, Craig M. ; Amsterdam, Ezra A ; Mason, Dean T. / Efficacy of beta adrenergic blockade in coronary heart disease : Propranolol in angina pectoris. In: Clinical Pharmacology and Therapeutics. 1975 ; Vol. 18, No. 5 PART 1. pp. 598-605.
@article{6ca42f4682b84b098dc47c474e7a8b66,
title = "Efficacy of beta adrenergic blockade in coronary heart disease: Propranolol in angina pectoris",
abstract = "Despite widespread clinical application of propranolol (P) in angina pectoris, convincing evidence of its efficacy has been incomplete, thereby resulting in continued controversy. Its antianginal effectiveness was investigated in 20 patients with documented coronary heart disease in a 44-wk study incorporating a prolonged 12-wk lead-in period, individualization of P dosage in a 6-wk dose-finding period, and a 24-wk double-blind crossover phase. On double-blind placebo, patients had 10.5 ± 2.1 anginal attacks and consumed 12.8 ± 3.0 nitroglycerin tablets (NTG) each week compared to 6.6 ± 1.5 anginal episodes (-37{\%}, p < 0.001) and 8.0 ± 1.7 NTG (-38{\%}, p < 0.001) when on P. No patient experienced more angina with P than with placebo. In addition, time to onset of chest pain during treadmill exercise was prolonged by P from 190 ± 16 to 248 ± 22 sec (+31 {\%}, p < 0.02) and ST depression was reduced from 1.7 ± 0.21 to 0.99 ± 0.18 mm (-42{\%}, p < 0.05). There was correlation (r = 0.64, p < 0.01) between per cent declines in anginal frequency and resting double product with P. Thus, propranolol favorably altered several indices of myocardial ischemia in severe coronary heart disease. This investigation clearly documents the clinical efficacy of optimal beta adrenergic blockade in coronary disease and provides objective justification for the judicious application of propranolol in treatment of angina pectoris.",
author = "Miller, {Richard R.} and Olson, {Harold G.} and Pratt, {Craig M.} and Amsterdam, {Ezra A} and Mason, {Dean T.}",
year = "1975",
month = "11",
language = "English (US)",
volume = "18",
pages = "598--605",
journal = "Clinical Pharmacology and Therapeutics",
issn = "0009-9236",
publisher = "Nature Publishing Group",
number = "5 PART 1",

}

TY - JOUR

T1 - Efficacy of beta adrenergic blockade in coronary heart disease

T2 - Propranolol in angina pectoris

AU - Miller, Richard R.

AU - Olson, Harold G.

AU - Pratt, Craig M.

AU - Amsterdam, Ezra A

AU - Mason, Dean T.

PY - 1975/11

Y1 - 1975/11

N2 - Despite widespread clinical application of propranolol (P) in angina pectoris, convincing evidence of its efficacy has been incomplete, thereby resulting in continued controversy. Its antianginal effectiveness was investigated in 20 patients with documented coronary heart disease in a 44-wk study incorporating a prolonged 12-wk lead-in period, individualization of P dosage in a 6-wk dose-finding period, and a 24-wk double-blind crossover phase. On double-blind placebo, patients had 10.5 ± 2.1 anginal attacks and consumed 12.8 ± 3.0 nitroglycerin tablets (NTG) each week compared to 6.6 ± 1.5 anginal episodes (-37%, p < 0.001) and 8.0 ± 1.7 NTG (-38%, p < 0.001) when on P. No patient experienced more angina with P than with placebo. In addition, time to onset of chest pain during treadmill exercise was prolonged by P from 190 ± 16 to 248 ± 22 sec (+31 %, p < 0.02) and ST depression was reduced from 1.7 ± 0.21 to 0.99 ± 0.18 mm (-42%, p < 0.05). There was correlation (r = 0.64, p < 0.01) between per cent declines in anginal frequency and resting double product with P. Thus, propranolol favorably altered several indices of myocardial ischemia in severe coronary heart disease. This investigation clearly documents the clinical efficacy of optimal beta adrenergic blockade in coronary disease and provides objective justification for the judicious application of propranolol in treatment of angina pectoris.

AB - Despite widespread clinical application of propranolol (P) in angina pectoris, convincing evidence of its efficacy has been incomplete, thereby resulting in continued controversy. Its antianginal effectiveness was investigated in 20 patients with documented coronary heart disease in a 44-wk study incorporating a prolonged 12-wk lead-in period, individualization of P dosage in a 6-wk dose-finding period, and a 24-wk double-blind crossover phase. On double-blind placebo, patients had 10.5 ± 2.1 anginal attacks and consumed 12.8 ± 3.0 nitroglycerin tablets (NTG) each week compared to 6.6 ± 1.5 anginal episodes (-37%, p < 0.001) and 8.0 ± 1.7 NTG (-38%, p < 0.001) when on P. No patient experienced more angina with P than with placebo. In addition, time to onset of chest pain during treadmill exercise was prolonged by P from 190 ± 16 to 248 ± 22 sec (+31 %, p < 0.02) and ST depression was reduced from 1.7 ± 0.21 to 0.99 ± 0.18 mm (-42%, p < 0.05). There was correlation (r = 0.64, p < 0.01) between per cent declines in anginal frequency and resting double product with P. Thus, propranolol favorably altered several indices of myocardial ischemia in severe coronary heart disease. This investigation clearly documents the clinical efficacy of optimal beta adrenergic blockade in coronary disease and provides objective justification for the judicious application of propranolol in treatment of angina pectoris.

UR - http://www.scopus.com/inward/record.url?scp=0016702423&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0016702423&partnerID=8YFLogxK

M3 - Article

VL - 18

SP - 598

EP - 605

JO - Clinical Pharmacology and Therapeutics

JF - Clinical Pharmacology and Therapeutics

SN - 0009-9236

IS - 5 PART 1

ER -