Key result
Transdermal nitroglycerin combined with benazepril significantly increased exercise duration at 1 mm ST depression and peak exercise at 2 and 22 hours post-dosing compared to placebo (P<0.05).
Why the study?
Does transdermal nitroglycerin in combination with benazepril improve exercise duration in patients with chronic stable angina pectoris?
RCT (n=24)
Double-blind
Latin square
Yes
Does transdermal nitroglycerin in combination with benazepril improve exercise duration in patients with chronic stable angina pectoris?
p-value: p=<0.05
The addition of an ACE inhibitor (benazepril) to transdermal nitroglycerin maintains antianginal efficacy at 22 hours post-dosing, mitigating the tolerance observed with nitroglycerin monotherapy.
Adding benazepril to transdermal nitroglycerin sustains antianginal efficacy at 22 hours in stable angina; confirms mitigation of nitrate tolerance with ACEI combination.
We have previously shown that transdermal nitroglycerin may induce an increase in the activity of the adrenergic and the renin-angiotensin-aldosterone systems (SRAA) in patients with chronic stable angina pectoris (SA); when the activation of these systems is more pronounced, the antianginal effect of this drug seems to be reduced. The aim of this study was to evaluate the antianginal efficacy of transdermal nitroglycerin administration (TTS-NG 10 mg.24 h-1) in combination with an ACE inhibitor without sulphydryl groups (BNZ, benazepril 10 mg b.i.d.) in respect to placebo, or to TTS-NG or BNZ administered as monotherapy. Twenty-four patients (21M, 3F) were admitted to this multicentre, randomized, double-blind, latin square, placebo-controlled study. Patients received all the treatments (placebo, TTS-NG, BNZ and BNZ + TTS-NG) each for one week; at the end of each week patients performed two exercise tests 2 and 22 h post-dosing. Two hours post-dosing, exercise duration at 1 mm ST depression was significantly increased in respect to placebo during TTS-NG (P < 0.05) and TTS-NG + BNZ (P < 0.05) treatments. Two hours post-dosing, exercise duration at peak exercise was also increased in respect to placebo during TTS-NG (P < 0.05) and TTS-NG + BNZ (P < 0.05); 22 h post-dosing the increase in exercise duration was significant only during TTS-NG + BNZ treatment (P < 0.05) in respect to placebo, but not during TTS-NG given alone. Rate-pressure product at 1 mm ST depression was significantly increased 2 h post-dosing during TTS-NG treatment (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Muiesan et al. (1993) conducted an RCT in Chronic stable angina pectoris (n=24). Transdermal nitroglycerin in combination with benazepril vs. Placebo, TTS-NG alone, or benazepril alone was evaluated on Exercise duration at 1 mm ST depression and at peak exercise (p=<0.05). Transdermal nitroglycerin combined with benazepril significantly increased exercise duration at 1 mm ST depression and peak exercise at 2 and 22 hours post-dosing compared to placebo (P<0.05).
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