Long-term effects of molsidomine on exercise tolerance in patients with exertional angina pectoris.

Molsidomine is a derivative of the sydnonimines and is a long-acting vasodilator that may be effective in the treatment of chronic stable angina pectoris. To evaluate the therapeutic efficacy and drug tolerance, eight men with stable angina pectoris performed a symptom-limited maximal exercise test on a computer-assisted treadmill. After ingesting either placebo or molsidomine administered in single blind fashion 90 min before the exercise test on the first day of treatment, molsidomine decreased the average systolic blood pressure response from 154 +/- 3 (SEM) to 135 +/- 4 mmHg (p less than 0.01). However it did not significantly change the average heart rate response (117 +/- 7 to 124 +/- 8 beats/min) and the rate-pressure product (18.1 +/- 1.2 X 10(3) to 16.8 +/- 1.1 X 10(3]. The average time up to the onset of ischemia at which significant ST-segment deviation (0.1 mV) first appeared was increased from 9.0 +/- 1.7 to 12.8 +/- 1.2 min (p less than 0.001) after molsidomine. At peak exercise after molsidomine, the mean value of ST-segment deviation in V5 or aVF was decreased (p less than 0.001). This result was obtained even though the average exercise duration was increased from 11.4 +/- 1.7 to 13.6 +/- 1.2 min (p less than 0.001). The treadmill score according to Hollenberg was also improved from -47 +/- 24 to 1 +/- 14 after molsidomine administration. After six weeks of continued therapy with molsidomine the favorable effect on exercise tolerance was significantly decreased in terms of exercise duration, the time up to the onset of ischemia, and the treadmill score.(ABSTRACT TRUNCATED AT 250 WORDS)