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

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.