A comparison of nisoldipine and nifedipine, in combination with atenolol, in the management of myocardial ischaemia

The effects of the addition of slow-release nifedipine 20 mgtwice daily and nisoldipine 10 mg twice daily to atenolol monotherapywere compared in a double-blind placebo-controlled study of24 patients with chronic stable angina pectoris. Neither nisoldipinenor nifedipine was associated with significant subjective benefitat these doses. Two hours post-dosing, exercise capacity improvedafter both nisoldipine (duration+37 s, P<0.01; time to angina+67s, P<0.01; time to sign ST depression+60 s, P<0.01) andnifedipine (duration +21 s, ns; time to angina+56 s, P<0.05;time to significant ST depression+49 s P<0.05) However, thisimprovement was not maintained 12 h post-dosing. Ambulatorymonitoring did not demonstrate a sign reduction in the amountof silent or total ischaemia following the addition of eithernifedipine or nisoldipine to atenolol monotherapy. There wasno significant difference between nifedipine and nisoldipinein any parameter tested. In conclusion, like slow-release n 20 mg, the effective durationof anti-ischaemic action of nisoldipine 10 mg is less than 12h. Since several patients experienced vasodilatory unwantedeffects, more frequent administration rather than larger individualdoses may be desirable to achieve a clinical response.