Nifedipine Monotherapy is Not Recommended in Unstable Angina But in combination with metoprolol it reduced recurrent ischaemia and Ml

In a multicentre randomised double-blind trial 515 patients admitted to hospital with unstable angina received treatment for ~ 48 hours. Those not on previous {j-blocker maintenance therapy received, in divided doses, placebo (n = 84), nifedipine 60mgf24 hours and placebo (n = 89), metoprolol 200mg/24 hours and placebo (n = 79) or nifedipine and metoprolol (n = 86). Those on previous {j-blocker maintenance therapy received placebo (n = 81) or nifedipine 60mg/24 hours (n = 96). Treatments were evaluated in terms of the rates of recurrence of ischaemia or myocardial infarction (MI) within 48 hours after startina treatment. Results were expressed as rate ratios between treatment groups. Among the patients not on previous {j-blocker maintenance therapy 18% of the nifedipine group vs 5-12% of the other 3 treatment groups were in the high risk category. Among the patients on previous {j-blocker maintenance therapy 22% in the nifedipine group vs 36% in the placebo group were in the high risk category.

Rate ratios for recurrent ischaemia or Ml within 48 hours in patients not on previous /3-blocker maintenance therapy relative to placebo were 1.15 for nifedipine, 0.76 for metoprolol and 0.80 for nifedipine and metoprolol. In patients on previous {j-blocker maintenance therapy the rate ratio was 0 68 for nifedipine. Rate ratios for Ml only in patients not previously receiving {j-blockers were 1.51 for nifedipine. 1.07 for metoprolol and 0.88 for combination treatment. In those previously receiving 13-blockers the rate ratio was 0.86 for nifedipine.

The authors therefore concluded that ' ... paUents whose condition has become unstable despite maintenance treatment with a p-blocker can be expected to react favourably to the addition of nlfedipine to a regimen of continued P·blockade' but as a monotherapy nifedipine was not recommended because of high incidence of MI. Lubsen J. Tlfssen JGP. Kerkkamp HJJ Bnt1sh Heart Journal 56 400·413, Nov 1986

0156-2703/87/0131-0009/0101.00/0 C> ADtS Press INPHARIIA8 31 Jan 1987 9