Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1984 Jul;52(1):53–56. doi: 10.1136/hrt.52.1.53

Beneficial effects of diltiazem in coronary artery disease.

J Kenny, K Daly, G Bergman, S Kerkez, D E Jewitt
PMCID: PMC481584  PMID: 6743423

Abstract

The effects of the new calcium channel blocking agent diltiazem were evaluated in 11 patients with stable angina pectoris and confirmed obstructive coronary artery disease at rest and during rapid atrial pacing. Symptomatic, metabolic, coronary, and systemic haemodynamic indices were monitored at rest and during pacing induced ischaemia. At rest, after the administration of intravenous diltiazem, potent vasodilator effects were observed with a significant fall in mean blood pressure and an increase in cardiac index. Importantly, however, the systemic vasodilator effect of diltiazem was associated with no significant increase in heart rate. During pacing there was similar decrease in mean blood pressure after diltiazem, and mean pacing time to angina increased significantly. Three patients did not develop angina on repeat pacing. Coupled with an improved pacing time to angina there was a significant improvement in myocardial lactate extraction during pacing, changing from lactate production to lactate extraction after diltiazem. This study confirms the antianginal effects of diltiazem and suggests that this agent may have advantages in the management of angina pectoris. The results suggest that diltiazem may exert its beneficial effect not only by reducing afterload reduction but also by a direct metabolic effect on the myocardium.

Full text

PDF
53

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bergman G., Atkinson L., Metcalfe J., Jackson N., Jewitt D. E. Beneficial effect of enhanced myocardial carbohydrate utilisation after oxfenicine (L-hydroxyphenylglycine) in angina pectoris. Eur Heart J. 1980 Aug;1(4):247–253. doi: 10.1093/oxfordjournals.eurheartj.a061126. [DOI] [PubMed] [Google Scholar]
  2. Braunwald E. Mechanism of action of calcium-channel-blocking agents. N Engl J Med. 1982 Dec 23;307(26):1618–1627. doi: 10.1056/NEJM198212233072605. [DOI] [PubMed] [Google Scholar]
  3. Ferlinz J., Turbow M. E. Antianginal and myocardial metabolic properties of verapamil in coronary artery disease. Am J Cardiol. 1980 Dec 1;46(6):1019–1026. doi: 10.1016/0002-9149(80)90361-6. [DOI] [PubMed] [Google Scholar]
  4. Franklin D., Millard R. W., Nagao T. Responses of coronary collateral flow and dependent myocardial mechanical function to the calcium antagonist, diltiazem. Chest. 1980 Jul;78(1 Suppl):200–204. doi: 10.1378/chest.78.1.200. [DOI] [PubMed] [Google Scholar]
  5. Ganz W., Tamura K., Marcus H. S., Donoso R., Yoshida S., Swan H. J. Measurement of coronary sinus blood flow by continuous thermodilution in man. Circulation. 1971 Aug;44(2):181–195. doi: 10.1161/01.cir.44.2.181. [DOI] [PubMed] [Google Scholar]
  6. Henry P. D. Comparative pharmacology of calcium antagonists: nifedipine, verapamil and diltiazem. Am J Cardiol. 1980 Dec 1;46(6):1047–1058. doi: 10.1016/0002-9149(80)90366-5. [DOI] [PubMed] [Google Scholar]
  7. Holmberg S., Varnauskas E. Coronary circulation during pacing-induced tachycardia. Acta Med Scand. 1971 Dec;190(6):481–490. doi: 10.1111/j.0954-6820.1971.tb07463.x. [DOI] [PubMed] [Google Scholar]
  8. Hossack K. F., Bruce R. A. Improved exercise performance in persons with stable angina pectoris receiving diltiazem. Am J Cardiol. 1981 Jan;47(1):95–101. doi: 10.1016/0002-9149(81)90296-4. [DOI] [PubMed] [Google Scholar]
  9. Jackson G., Atkinson L., Oram S. Improvement of myocardial metabolism in coronary arterial disease by beta-blockade. Br Heart J. 1977 Aug;39(8):829–833. doi: 10.1136/hrt.39.8.829. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kaltenbach M., Schulz W., Kober G. Effects of nifedipine after intravenous and intracoronary administration. Am J Cardiol. 1979 Oct 22;44(5):832–838. doi: 10.1016/0002-9149(79)90205-4. [DOI] [PubMed] [Google Scholar]
  11. Kawai C., Konishi T., Matsuyama E., Okazaki H. Comparative effects of three calcium antagonists, diltiazem, verapamil and nifedipine, on the sinoatrial and atrioventricular nodes. Experimental and clinical studies. Circulation. 1981 May;63(5):1035–1042. doi: 10.1161/01.cir.63.5.1035. [DOI] [PubMed] [Google Scholar]
  12. Lynch P., Dargie H., Krikler S., Krikler D. Objective assessment of antianginal treatment: a double-blind comparison of propranolol, nifedipine, and their combination. Br Med J. 1980 Jul 19;281(6234):184–187. doi: 10.1136/bmj.281.6234.184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Millard R. W., Lathrop D. A., Grupp G., Ashraf M., Grupp I. L., Schwartz A. Differential cardiovascular effects of calcium channel blocking agents: potential mechanisms. Am J Cardiol. 1982 Feb 18;49(3):499–506. doi: 10.1016/s0002-9149(82)80002-7. [DOI] [PubMed] [Google Scholar]
  14. Sasayama S., Takahashi M., Nakamura M., Ohyagi A., Yamamoto A., Shimada T., Kawai C. Effect of diltiazem on pacing-inducing ischemia in conscious dogs with coronary stenosis: improvement of postpacing deterioration of ischemic myocardial function. Am J Cardiol. 1981 Sep;48(3):460–467. doi: 10.1016/0002-9149(81)90073-4. [DOI] [PubMed] [Google Scholar]
  15. Sato M., Nagao T., Yamaguchi I., Nakajima H., Kiyomoto A. Pharmacological studies on a new l,5-benzothiazepine derivative (CRD-401). Arzneimittelforschung. 1971 Sep;21(9):1338–1343. [PubMed] [Google Scholar]
  16. Stone D. L., Stephens J. D., Banim S. O. Coronary haemodynamic effects of nifedipine. Comparison with glyceryl trinitrate. Br Heart J. 1983 May;49(5):442–446. doi: 10.1136/hrt.49.5.442. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Strauss W. E., McIntyre K. M., Parisi A. F., Shapiro W. Safety and efficacy of diltiazem hydrochloride for the treatment of stable angina pectoris: report of a cooperative clinical trial. Am J Cardiol. 1982 Feb 18;49(3):560–566. doi: 10.1016/s0002-9149(82)80012-x. [DOI] [PubMed] [Google Scholar]
  18. Subramanian V. B., Lahiri A., Paramasivan R., Raftery E. B. Verapamil in chronic stable angina. A controlled study with computerized multistage treadmill exercise. Lancet. 1980 Apr 19;1(8173):841–844. doi: 10.1016/s0140-6736(80)91351-3. [DOI] [PubMed] [Google Scholar]
  19. Walsh R. A., Badke F. R., O'Rourke R. A. Differential effects of systemic and intracoronary calcium channel blocking agents on global and regional left ventricular function in conscious dogs. Am Heart J. 1981 Sep;102(3 Pt 1):341–350. doi: 10.1016/0002-8703(81)90307-0. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES