氨氯地平、阿替洛尔及其联合用药对平板运动及动态监测期间心肌缺血的影响。加拿大氨氯地平/阿替洛尔无症状性缺血研究（CASIS）调查组。

Effect of amlodipine, atenolol and their combination on myocardial ischemia during treadmill exercise and ambulatory monitoring. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

作者信息

Davies R F, Habibi H, Klinke W P, Dessain P, Nadeau C, Phaneuf D C, Lepage S, Raman S, Herbert M, Foris K

机构信息

University of Ottawa Heart Institute, Ontario, Canada.

出版信息

J Am Coll Cardiol. 1995 Mar 1;25(3):619-25. doi: 10.1016/0735-1097(94)00436-t.

DOI:10.1016/0735-1097(94)00436-t

PMID:7860905

Abstract

OBJECTIVES

This study compared the effects of amlodipine, atenolol and their combination on ischemia during treadmill testing and 48-h ambulatory monitoring.

BACKGROUND

It is not known whether anti-ischemic drugs exert similar effects on ischemia during ambulatory monitoring and exercise treadmill testing.

METHODS

Patients with stable coronary artery disease and ischemia during treadmill testing and ambulatory monitoring were randomized to receive amlodipine (n = 51) or atenolol (n = 49). Each group underwent a counterbalanced, crossover evaluation of single drug and placebo, followed by evaluation of the combination.

RESULTS

Amlodipine and the combination prolonged exercise time to 0.1-mV ST segment depression by 29% and 34%, respectively (p < 0.001) versus 3% for atenolol (p = NS). During ambulatory monitoring, the frequency of ischemic episodes decreased by 28% with amlodipine (p = 0.083 [NS]), by 57% with atenolol (p < 0.001) and by 72% with the combination (p < 0.05 vs. both single drugs; p < 0.001 vs. placebo). Suppression of ischemia during exercise testing and ambulatory monitoring was similar in patients with and without exercise-induced angina. Exercise time to angina improved by 29% with amlodipine (p < 0.01), by 16% with atenolol (p < 0.05) and by 39% with the combination (p < 0.005 vs. placebo, atenolol and amlodipine). In patients with angina, total exercise time improved by 16% with amlodipine (p < 0.001), by 4% with atenolol (p = NS) and by 19% with the combination (p < 0.05 vs. placebo and either single drug). In those patients without angina, no therapy significantly improved total exercise time.

CONCLUSIONS

Ischemia during treadmill testing was more effectively suppressed by amlodipine, whereas ischemia during ambulatory monitoring was more effectively suppressed by atenolol. The combination was more effective than either single drug in both settings.

摘要

目的

本研究比较了氨氯地平、阿替洛尔及其联合用药对平板运动试验及48小时动态监测期间缺血情况的影响。

背景

尚不清楚抗缺血药物在动态监测及运动平板试验期间对缺血情况是否有相似的作用。

方法

在平板运动试验及动态监测期间有稳定型冠状动脉疾病及缺血情况的患者被随机分为接受氨氯地平组（n = 51）或阿替洛尔组（n = 49）。每组均接受单药及安慰剂的平衡交叉评估，随后评估联合用药情况。

结果

与阿替洛尔使运动时间延长至0.1 mV ST段压低3%（p = 无显著性差异）相比，氨氯地平及联合用药分别使运动时间延长至0.1 mV ST段压低29%及34%（p < 0.001）。在动态监测期间，氨氯地平使缺血发作频率降低28%（p = 0.083[无显著性差异]），阿替洛尔使其降低57%（p < 0.001），联合用药使其降低72%（与两种单药相比p < 0.05；与安慰剂相比p < 0.001）。在有或无运动诱发心绞痛的患者中，运动试验及动态监测期间对缺血的抑制作用相似。氨氯地平使至心绞痛的运动时间改善29%（p < 0.01），阿替洛尔使其改善16%（p < 0.05），联合用药使其改善39%（与安慰剂、阿替洛尔及氨氯地平相比p < 0.005）。在有心绞痛的患者中，氨氯地平使总运动时间改善16%（p < 0.001），阿替洛尔使其改善4%（p = 无显著性差异），联合用药使其改善19%（与安慰剂及任一单药相比p < 0.05）。在无心绞痛的患者中，无治疗方法能显著改善总运动时间。