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October 1, 1989European Heart Journal

Sustained-release diltiazem versus metoprolol in stable angina pectoris

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Key result

Sustained-release diltiazem increased total exercise time more than metoprolol (1.2 min vs 0.4 min, P=0.02) in patients with stable angina.

Why the study?

Does sustained-release diltiazem improve exercise capacity and reduce anginal attacks compared to metoprolol in patients with stable angina?

Population

12 patients with stable angina

Comparison

Sustained-release diltiazem 120 mg twice daily… vs Metoprolol 100 mg twice daily for 3 weeks

Design

RCT, Randomized crossover design, Double-blind

Follow-up

3 weeks per treatment period

Authors

JPJan L. PosmaImperial College LondonRDR.B. Van DijkZuyderland Medisch CentrumKLK. I. LieUniversity Medical Center Groningen

Discussion

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Implication

Diltiazem-SR may be preferred over metoprolol for exercise capacity in stable angina; extends head-to-head data on functional versus symptomatic endpoints.

Study Design

Type

RCT (n=12)

Blinding

Double-blind

Randomization

randomized crossover

Structured PICO

Does sustained-release diltiazem improve exercise capacity and reduce anginal attacks compared to metoprolol in patients with stable angina?

P
Population
12 patients with stable angina evaluated in a crossover design with two 3-week treatment periods following a 1-week placebo period.
I
Intervention
Sustained-release diltiazem (diltiazem-SR) 120 mg twice daily (b.i.d.) for 3 weeks
C
Comparator
Metoprolol 100 mg twice daily (b.i.d.) for 3 weeks (crossover design)
O
Outcome
Total exercise timesurrogate

Main Result

Absolute Event Rate: 1.2% vs 0.4%

p-value: p=0.02

Sustained-release diltiazem improves exercise capacity more than metoprolol at 12 hours post-dose in stable angina, though both drugs equally reduce the frequency of anginal attacks.

Limitations

  • Tests were performed 12 hours after drug administration, resulting in metoprolol plasma levels being below the therapeutic range.
  • Tests were performed 12 hours after drug administration, leading to subtherapeutic metoprolol plasma levels
  • Small sample size (n=12)

Cite This Study

Posma et al. (1989) conducted an RCT in stable angina (n=12). Sustained-release diltiazem vs. Metoprolol 100 mg b.i.d. was evaluated on Increase in total exercise time (p=0.02). Sustained-release diltiazem increased total exercise time more than metoprolol (1.2 min vs 0.4 min, P=0.02) in patients with stable angina.

synapsesocial.com/papers/6a68af5387102babaff7daf7https://doi.org/10.1093/oxfordjournals.eurheartj.a059403
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Dilitiazem in Comparison with metoprolol in stable angina pectoris1988 · 18 citations
  2. 2Twenty‐four hour efficacy of two dose levels of a once daily sustained‐ release diltiazem formulation in stable angina: a placebo‐controlled trial. The Dildurang Study Group.1995 · 5 citations
  3. 3Diltiazem in the Treatment of Mild or Moderate Essential Hypertension. Comparison with Metoprolol in a Crossover Double‐Blind Trial1984 · 44 citations
  4. 4Beneficial effects of high-dose diltiazem in patients with persistent effort angina on beta-blockers and nitrates: a randomized, double-blind, placebo-controlled cross-over study.1985 · 62 citations
  5. 5Increased exercise tolerance and reduced electrocardiographic ischemia with diltiazem in patients with stable angina pectoris.1982 · 68 citations