Ahuja R C, Sinha N, Kumar R R, Saran R K
Department of Medicine, King George Medical College, Lucknow, India.
Int J Cardiol. 1993 Oct 1;41(3):191-9. doi: 10.1016/0167-5273(93)90115-w.
We conducted a randomised controlled trial to study the effects of metoprolol and diltiazem on the total ischaemic burden--sum of symptomatic and silent myocardial ischaemia, in 146 patients with stable angina pectoris. One-hundred thirty-four completed the study protocol. Sixty-eight patients received metoprolol (100 mg twice daily, n = 52, 50 mg twice daily, n = 16) while 66 received diltiazem (90 mg three times daily, n = 50, 60 mg three times daily, n = 16). The drugs were given for 4 weeks. The primary outcome variables were frequency and duration of total ischaemic burden, silent and symptomatic myocardial ischaemia. These were measured on 48 h of Holter monitoring. The reductions in duration and frequency of total ischaemic burden by metoprolol, 76% and 40%, respectively, were significantly higher than by diltiazem, 43% and 24%, respectively (P < 0.01 and P < 0.02). The frequency and duration of silent myocardial ischaemia, which constituted more than 80% of the total ischaemic burden in the two groups showed similar results. However, the reduction in frequency of symptomatic myocardial ischaemia only was significantly greater by metoprolol (63% than diltiazem (24%) as the difference in reduction of duration of symptomatic ischaemia was insignificant (85% vs. 75%; P > 0.05). Whether a greater reduction of total ischaemic burden by metoprolol as compared to diltiazem has any implications for prognosis in patients with chronic stable angina remains to be established.
我们进行了一项随机对照试验，以研究美托洛尔和地尔硫䓬对146例稳定型心绞痛患者总的缺血负荷（症状性和无症状性心肌缺血之和）的影响。134例患者完成了研究方案。68例患者接受美托洛尔治疗（每日2次，每次100mg，n = 52；每日2次，每次50mg，n = 16），而66例患者接受地尔硫䓬治疗（每日3次，每次90mg，n = 50；每日3次，每次60mg，n = 16）。药物治疗4周。主要结局变量为总的缺血负荷、无症状性和症状性心肌缺血的发生频率和持续时间。这些指标通过动态心电图监测48小时来测量。美托洛尔使总的缺血负荷的持续时间和发生频率分别降低了76%和40%，显著高于地尔硫䓬的43%和24%（P < 0.01和P < 0.02）。无症状性心肌缺血的发生频率和持续时间在两组总的缺血负荷中占比均超过80%，结果相似。然而，仅美托洛尔使症状性心肌缺血发生频率的降低幅度显著大于地尔硫䓬（63%比24%），因为症状性缺血持续时间降低幅度的差异不显著（85%对75%；P > 0.05）。与地尔硫䓬相比，美托洛尔对总的缺血负荷有更大幅度的降低，这对慢性稳定型心绞痛患者的预后是否有任何影响仍有待确定。
