[Treatment of hypertrophic cardiomyopathy with nifedipine and propranolol in combination].

Fifteen patients (14 males and 1 female) with hypertrophic cardiomyopathy, ranging from 22 to 67 years of age (mean: 45.5 years) were treated with oral nifedipine and propranolol for 6 to 24 (mean: 18) months. Twelve of the patients had been pretreated with a mean oral dose of 560 mg verapamil for 60 to 93 (mean 78.5) months, showing slight subjective and objective improvement. Treatment with nifedipine and propranolol was terminated in five cases, due to deterioration or side effects after 6 and 12 months, respectively. During combined therapy, two patients reported improvement, whereas in five cases there was no change and eight patients reported deterioration. There was no change in the Sokolow index. The radiologically determined heart volume increased in 10 out of 15 patients and in the total group from 887 +/- 214 to 938 +/- 248 ml/1.73 m2. Echocardiographic measurements showed a significant increase in left atrial diameter from 40.0 +/- 9 to 44.0 +/- 11 mm, whereas ventricular wall thickness remained unchanged. Thus, high-dose verapamil therapy seems superior to nifedipine-propranolol therapy in patients with hypertrophic cardiomyopathy.