van Dijk R B, Lie K I, Crijns H J
Department of Cardiology (Thoraxcentre), University Hospital Groningen, The Netherlands.
Eur Heart J. 1988 Nov;9(11):1194-9. doi: 10.1093/oxfordjournals.eurheartj.a062429.
The efficacy of diltiazem in comparison with metoprolol in chronic stable angina was assessed in 33 male patients during a 15-week blind cross-over study. After an initial two-week run-in period, baseline measurements were made. Subsequently, the patients entered a blind cross-over study consisting of two six-week treatment periods with diltiazem 240 mg (60 mg q.i.d.) or metoprolol 200 mg (100 mg b.i.d.). Dose adjustment to either 360 mg diltiazem (120 t.i.d.) or 400 mg metoprolol (200 b.i.d.) was allowed two weeks after the start of treatment. There was a one-week washout period between the two treatment periods. Compared to baseline values both drugs reduced the number of anginal attacks (diltiazem - 55%, P = 0.02; metoprolol - 73%, P = 0.01) and showed improvement of the measured exercise variables (exercise duration: diltiazem + 16%, P less than 0.001; metoprolol + 4%, P = NS; time to angina: diltiazem + 21%, P = 0.02, metoprolol + 14%, P = NS; maximal ST-depression: diltiazem + 13%, P = NS, metoprolol + 33%, P = 0.002). No significant change in LVEF was noticed. Both drugs reduced the mean heart rate on Holter tape (diltiazem - 11%, P = 0.006; metoprolol - 14%, P = 0.004). No effects on conduction were noticed. Although at the borderline of significance, diltiazem increased the total exercise duration as compared to metoprolol (16 vs. 4%, P = 0.05). It is concluded that diltiazem improves exercise tolerance in patients with stable angina pectoris and appears to be a safe and effective alternative to the beta-blocking agent metoprolol.(ABSTRACT TRUNCATED AT 250 WORDS)
在一项为期15周的双盲交叉研究中，对33名男性患者评估了地尔硫䓬与美托洛尔治疗慢性稳定型心绞痛的疗效。在最初为期两周的导入期后，进行了基线测量。随后，患者进入双盲交叉研究，包括两个为期六周的治疗期，分别使用240毫克地尔硫䓬（60毫克，每日四次）或200毫克美托洛尔（100毫克，每日两次）。治疗开始两周后，允许将剂量调整为360毫克地尔硫䓬（120毫克，每日三次）或400毫克美托洛尔（200毫克，每日两次）。两个治疗期之间有一周的洗脱期。与基线值相比，两种药物均减少了心绞痛发作次数（地尔硫䓬 - 55%，P = 0.02；美托洛尔 - 73%，P = 0.01），并改善了测量的运动变量（运动持续时间：地尔硫䓬 + 16%，P < 0.001；美托洛尔 + 4%，P = 无统计学意义；心绞痛发作时间：地尔硫䓬 + 21%，P = 0.02，美托洛尔 + 14%，P = 无统计学意义；最大ST段压低：地尔硫䓬 + 13%，P = 无统计学意义，美托洛尔 + 33%，P = 0.002）。未发现左室射血分数有显著变化。两种药物均降低了动态心电图记录的平均心率（地尔硫䓬 - 11%，P = 0.006；美托洛尔 - 14%，P = 0.004）。未发现对传导有影响。尽管处于显著性临界值，但与美托洛尔相比，地尔硫䓬增加了总运动持续时间（16%对4%，P = 0.05）。结论是，地尔硫䓬可提高稳定型心绞痛患者的运动耐量，似乎是β受体阻滞剂美托洛尔的一种安全有效的替代药物。（摘要截断于250字）
