What is the clinical evidence from this study?

Study design: Observational. Population: Hypertrophic cardiomyopathy (n=15). Intervention: Nifedipine and propranolol vs. Baseline.

January 1, 1988

Effects of nifedipine and propranolol combined therapy in patients with hypertrophic cardiomyopathy

RHR. HopfGoethe University Frankfurt MKM. KaltenbachGoethe University Frankfurt

Key Result

Combined nifedipine and propranolol therapy was evaluated in 15 patients with hypertrophic cardiomyopathy, but clinical outcomes are not reported in the provided text.

Study Design

Type

Observational (n=15)

Multicenter

Structured PICO

Does combined nifedipine and propranolol therapy improve clinical symptoms and cardiac structure in patients with hypertrophic cardiomyopathy?

Population

15 patients (14 male, 1 female) with hypertrophic cardiomyopathy, age 22 to 67 (mean 45.5) years. 12 patients were pretreated with high-dose verapamil.

Intervention

Oral nifedipine and propranolol combined therapy for 6 to 24 (mean 18) months.

Comparator

Baseline status and prior treatment with oral verapamil (mean dose 560 mg for mean 78.5 months).

Outcome

Subjective clinical status, radiologically determined heart volume, and echocardiographic measurements (left atrial diameter and ventricular wall thickness).surrogate

Combined nifedipine and propranolol therapy in hypertrophic cardiomyopathy is associated with clinical deterioration and adverse structural changes, suggesting high-dose verapamil is a superior strategy.

Limitations

Small sample size
Lack of a separate control group
Incomplete text missing results

Abstract

Fifteen (14 male and one female) patients with hypertrophic cardiomyopathy, ranging from 22 to 67 (mean: 45.5) years of age 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 up to 93 (mean: 78.5) months, showing slight subjective and objective improvement. Treatment with nifedipine-propranolol was terminated in five cases due to deterioration or side effects after 6 and 12 months, respectively. During combined therapy, two patients reported subjective improvement, but in five cases there was no change and eight patients reported deterioration. The mean Sokolow-index showed no change. The radiologically determined heart volume increased in 11/15 patients and significantly in the mean of all patients from 887 +/- 239 to 947 +/- 246 ml/m2. In addition, echocardiographic measurements showed a significant increase in left atrial diameter from 40.0 +/- 9 to 42.1 +/- 9 mm, whereas ventricular wall thickness remained unchanged. Thus, high dose verapamil therapy seems superior to nifedipine-propranolol therapy in most patients with hypertrophic cardiomyopathy.

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