曲米他嗪抗心肌缺血的临床观察

目的 评价抗心肌缺血新药曲米他嗪与传统抗心肌缺血药结合治疗稳定性劳累型心绞痛的临床疗效。方法 22例稳定性劳累型心绞痛患经临床及运动试验证实其心肌缺血后入选，予曲米他嗪治疗12wk后复查运动试验并判断临床疗效。结果 与试验前相比运动耐量和总工作量显提高（P＜0．01），运动至心绞痛发作时间明显延长，ST段压低程度亦显改善（P均＜0．01），患周心绞痛发作次数及硝酸甘油消耗量显下降（P＜0．01）。结论 曲米他嗪与传统抗心肌缺血药物联合使用时有显的抗心肌缺血作用，增加运动耐量，安全有效。     

Trimetazidine. A review of its use in stable angina pectoris and other coronary conditions.

The orally administered antianginal agent trimetazidine increases cell tolerance to ischaemia by maintaining cellular homeostasis. In theory, this cytoprotective activity should limit myocyte loss during ischaemia in patients with angina pectoris. Data from studies in patients with coronary artery disease indicate that, unlike the effects of other antianginals, the anti-ischaemic effects of trimetazidine 20 mg are not associated with alterations in haemodynamic determinants of myocardial oxygen consumption such as heart rate, systolic blood pressure and the rate-pressure product. Furthermore, limited evidence suggests trimetazidine may improve left ventricular function in patients with chronic coronary artery disease or ischaemic cardiomyopathy and in patients experiencing acute periods of ischaemia when undergoing percutaneous transluminal coronary angioplasty. Clinical studies have shown that oral trimetazidine 20 mg 3 times daily reduces the frequency of anginal attacks and nitroglycerin use and increases exercise capacity when used as monotherapy in patients with angina pectoris. Its clinical effects are broadly similar to those of nifedipine 40 mg/day and propranolol 120 to 160 mg/day but, unlike these agents, trimetazidine does not affect the rate-pressure product during peak exercise or at rest. Adjunctive trimetazidine 60 mg/day reduces the frequency of anginal attacks and nitroglycerin use and improves exercise capacity in patients with angina pectoris not sufficiently controlled by conventional antianginal agents. Furthermore, the drug appears to be more effective than isosorbide dinitrate 30 mg/day when used adjunctively in patients with angina pectoris poorly controlled by propranolol 120 mg/day. The tolerability profile of trimetazidine 60 mg/day was similar to that of placebo when used as add-on therapy in patients with angina pectoris insufficiently controlled by other antianginal agents and was superior to that of either nifedipine 40 mg/day or propranolol 120 to 160 mg/day when used as monotherapy. The most frequently reported adverse events in trimetazidine recipients were gastrointestinal disorders, although the incidence of these events was low. CONCLUSIONS: Trimetazidine is an effective and well tolerated anti-ischaemic agent which, in addition to providing symptom relief and functional improvement in patients with angina pectoris, has a cytoprotective action during ischaemia. The drug is suitable for initial use as monotherapy in patients with angina pectoris and, because of its different mechanism of action, as adjunctive therapy in those with symptoms not sufficiently controlled by nitrates, beta-blockers or calcium antagonists. The role of trimetazidine in other coronary conditions has yet to be clearly established.     

An 8-week double-blind study of amlodipine and diltiazem in patients with stable exertional angina pectoris

A multicenter, double-blind study was performed to compare the antianginal efficacy and safety of the new dihydropyridine calcium antagonist amlodipine with the benzothiazepine calcium antagonist diltiazem in patients with stable exertional angina pectoris. Following a 2-week placebo run-in period, 39 patients were randomized to receive amlodipine (2.5-10 mg once daily) and 41 patients to receive diltiazem (60-120 mg three times daily) in an 8-week double-blind treatment phase. The study used standardized bicycle exercise testing as a primary efficacy assessment. Patients also recorded angina frequency and nitroglycerin (NTG) tablet consumption/ week. Treatment with amlodipine and diltiazem resulted in an improvement in total exercise time, time to angina and total work, mean ST-segment deviation at maximum common load, median number of angina attacks/week, and NTG tablet consumption/week. The incidence and severity of possibly treatment-related side effects and laboratory test abnormalities were comparable for both drugs. The most frequently reported side effects were dizziness, headache, peripheral edema, and nausea. Two patients withdrew from diltiazem treatment due to pruritus in one case and severe headache and moderate dyspnea in the other. No amlodipine-treated patients withdrew due to side effects. In conclusion, this study demonstrated that the antianginal efficacy and tolerability of amlodipine is equivalent to diltiazem, but amlodipine has the advantage of once-daily dosing.     

曲美他嗪对心绞痛患者50例临床疗效观察

目的:观察曲美他嗪[1-(2,3,4三-甲基苯唑)哌嗪二氢盐酸盐]治疗心绞痛的临床疗效。方法:观察50例心绞痛患者采用曲美他嗪治疗前后的心绞痛发作次数、硝酸甘油消耗量、运动试验结果、静息心电图、心率及血压。结果:曲美他嗪治疗后心绞痛患者的心绞痛发作次数、硝酸甘油消耗量、总运动时间、静息心电图较治疗前有明显改善(P<0.01),心率及血压无明显变化。结论:曲美他嗪可改善接受常规治疗心绞痛患者的临床表现。     

曲美他嗪治疗老年冠心病稳定性心绞痛的疗效观察

目的分析研究曲美他嗪治疗老年冠心病稳定性心绞痛的临床疗效。方法选择老年冠心病稳定性心绞痛62例,随机分为治疗组和对照组各31例,对照组常规服用阿司匹林、β-受体阻滞剂、硝酸酯类和他汀类药物,治疗组在对照组治疗的基础上加曲美他嗪,疗程均为8周;比较两组患者治疗前后每周心绞痛发作次数、硝酸甘油用量及心电图、血压、心率变化等指标。结果治疗8周后,临床疗效治疗组（90.32%）明显优于对照组（70.97%）,心电图改善情况治疗组（83.87%）优于对照组（67.74%）,但差异均无统计学意义;两组患者心绞痛发作次数、硝酸甘油消耗量均较治疗前显著减少,与对照组比较,治疗组减少更明显（P〈0.05）;治疗期间两组均未见明显不良反应发生。结论曲美他嗪治疗老年冠心病稳定性心绞痛疗效确切,可有效改善心绞痛症状,值得临床推广使用。     

Effect of Antianginal Drugs in Stable Angina on Predicted Mortality Risk after Surviving a Myocardial Infarction

Background

Although antianginal drugs are used over several months and through to years in stable angina, there is scant evidence regarding their influence on outcomes. The METRO (ManagEment of angina: a reTRospective cOhort) study sought to assess the independent effect of using these drugs on subsequent mortality risk in patients with stable angina.

Methods

Consecutive patients with stable angina, receiving at least one antianginal drug (nitrates, β-adrenoceptor antagonists, calcium channel antagonists, trimetazidine, or nicorandil), were selected if they were discharged alive from an intensive care unit following a myocardial infarction (MI). Their case-record data were used in a multivariate logistic regression model to examine the independent association of antianginal drug use prior to the MI with predicted post-discharge, 6-month, all-cause mortality risk.

Results

In 353 patients, of whom 287 (81.3%) were men, the mean (±SD) age was 55 (±10.2) years and duration of treated stable angina was 27.2 (±24.8) months. The odds ratios (95% CI) of 6-month, all-cause mortality after surviving an MI were: for treatment that included a β-adrenoceptor antagonist, 0.63 (0.26, 1.52; p = 0.309); a calcium channel antagonist, 0.76 (0.12, 2.89; p = 0.638); a nitrate, 0.52 (0.26, 1.05; p = 0.070); nicorandil, 0.62 (0.29, 1.33; p = 0.221); and trimetazidine, 0.36 (0.15, 0.86; p = 0.022).

Conclusion

The inclusion of trimetazidine in the antianginal treatment of stable angina is independently associated with a significant reduction in mortality after surviving an MI. This suggests that combining a metabolic agent with drugs that modulate oxygen supply and demand, early in the management of stable angina, may confer a survival benefit.     

曲美他嗪治疗稳定型心绞痛的疗效观察

目的:观察曲美他嗪辅助治疗稳定型心绞痛的疗效和安全性。方法:选择稳定型心绞痛患者110例,随机分为两组,对照组(52例)为常规心绞痛用药,曲美他嗪组(58例)在常规用药基础上加用曲美他嗪20mg,口服,每日3次,连续8周。结果:曲美他嗪组治疗总有效率高于对照组,差异有显著性(P<0.05);两组均无不良反应发生。结论:在常规药物治疗基础上加用曲美他嗪能更有效地缓解心绞痛,使运动耐量增加,且耐受性好,因此曲美他嗪是辅助治疗心绞痛安全、有效的药物。     

Antianginal Effects of Trimetazidine and Left Ventricular Function Improvement in Patients with Stable Angina Pectoris

Objective

To evaluate the effects of add-on treatment with trimetazidine, single dose and long-term, on clinical and objective parameters of ischemia in patients with stable angina pectoris receiving standard antianginal therapy.

Design

One-month single-blind, placebo-controlled study.

Patients

40 patients with stable angina pectoris.

Interventions

Patients received 1-month treatment with either trimetazidine 20mg (n = 20) or placebo (n = 20) 3 times daily in addition to standard antianginal therapy.

Main outcome measures

All patients underwent bicycle stress tests at baseline and at 1 month to assess exercise tolerance. Patients receiving trimetazidine also underwent a stress test 2 hours after administration of a 60mg single dose. Influence of trimetazidine on stress-induced left ventricular function was assessed in 11 patients, with dobutamine stress echocardiography performed at baseline and at 1 month. Clinical efficacy was evaluated in terms of mean weekly number of anginal episodes and weekly nitroglycerin (glyceryl trinitrate) tablet consumption during the study.

Results

Trimetazidine significantly improved most stress test parameters, after a single dose and after 1 month of treatment; the rate-pressure product remained unchanged. Dobutamine tests showed significant (p < 0.05) increases from baseline values in time to onset of anginal pain and threshold dobutamine dose (13.5 ± 0.7 versus 10.2 ± 0.8 min, and 43.6 ± 2.8 versus 35.4 ± 3.4 μg/kg/min, respectively). The severity of anginal pain and mean weekly number of anginal episodes was reduced significantly (p < 0.05) from baseline values after 1 months’ treatment with trimetazidine (1.3 ± 0.6 versus 2.3 ± 0.3, and 6.6 ± 1.4 versus 10.1 ± 1.3, respectively). After 1 month, weekly consumption of nitroglycerin tablets was decreased by 3.1 from baseline values in the trimetazidine group but increased by 0.3 in the placebo-treated group. No patient withdrew due to treatment-related adverse effects.

Conclusion

This study confirms the antianginal and anti-ischemic efficacy of single dose and long-term treatment with trimetazidine. Treatment with trimetazidine was well tolerated.     

曲美他嗪治疗劳力型心绞痛临床观察

目的：观察曲美他嗪治疗经冠状动脉造影确诊的劳力型心绞痛的临床疗效。方法：观察曲美他嗪治疗（60mg,d）前后50例劳力型心绞痛患者的心绞痛发作次数、硝酸甘油消耗量、总运动时间、运动达到ST段压低1mm和出现心绞痛的时间、心率及血压。结果：曲美他嗪洽疗后劳力型心绞痛患者的心绞痛发作次数、硝酸甘油消耗量、总运动时间、运动达到ST段压低1mm和出现心绞痛的时间较治疗前明显改善（P〈0．01）;心率及血压无明显变化。结论：曲美他嗪可改善接受常规治疗的劳力型心绞痛患者的临床表现。     

曲美他嗪联合地尔硫卓治疗心绞痛的疗效

目的观察曲美他嗪联合地尔硫卓治疗心绞痛的疗效。方法选取笔者所在医院心绞痛患者50例,随机分为治疗组和对照组。对照组给予休息、吸氧、镇静、抗凝和抗血小板聚集等常规抗心绞痛处理,治疗组在此基础上,给予口服曲美他嗪片和地尔硫卓片,治疗2周后观察疗效和心电图情况。结果治疗组总有效率88%,对照组总有效率64%,治疗组疗效明显高于对照组,差异有统计学意义(P<0.01)。两组心电图改变情况比较,治疗组总有效率72%,对照组总有效率52%,治疗组心电图改变情况明显优于对照组,差异有统计学意义(P<0.01)。治疗后,治疗组使用硝酸甘油情况明显较对照组少,差异有统计学意义(P<0.01)。两组均未发现皮疹等过敏反应,也未发现肝肾功能损害。结论在常规治疗心绞痛的基础上,使用曲美他嗪联合地尔硫卓片治疗心绞痛,能够取得满意效果,值得临床推广。     

曲美他嗪与美托洛尔联合治疗稳定型心绞痛

目的 :评价曲美他嗪和美托洛尔联合治疗稳定型心绞痛的疗效。方法 :选择稳定型心绞痛的病人 94例 ,随机分成 2组。治疗组 4 8例给曲美他嗪 2 0mg ,po ,tid和美托洛尔 12 .5mg ,po ,bid ,疗程 4wk。对照组 4 6例给美托洛尔 12 .5mg ,po ,bid及安慰剂 ,po ,tid ,疗程 4wk。结果 :治疗前后 2组心绞痛发作次数 ,硝酸甘油消耗量和静息、运动时血压心率的二项乘积差值分别为 (- 6± 4 )次·wk- 1和 (- 3.3± 2 .2 )次·wk- 1,(- 4± 3)mg·wk- 1和(- 2 .1± 1.4 )mg·wk- 1,- 1198± 4 5 8和 - 82 8±5 36,- 2 0 0 6± 1131和 - 616± 14 65 (P <0 .0 1)。结论 :曲美他嗪联合美托洛尔治疗稳定型心绞痛疗效确切。     

A 6-week double-blind comparison of amlodipine and placebo in patients with stable exertional angina pectoris receiving concomitant beta-blocker therapy

This study was a multicenter, double-blind comparison of the antianginal efficacy and safety of amlodipine and placebo as adjunctive therapy with constant recommended maintenance doses of beta-blockers. Patients with stable exertional angina pectoris were randomized to placebo or amlodipine at a starting dose of 5 mg once daily. The amlodipine dose was adjusted to 10 mg daily after 2 weeks if angina attacks were not abolished. Antianginal efficacy was assessed throughout the study with angina diaries, investigators' and patients' global evaluations, and with bicycle exercise tests during a placebo run-in period (baseline) and after 2 and 6 weeks of double-blind treatment. On baseline-final analysis, the exercise time to angina onset increased by 13% with amlodipine compared to 6% with placebo (p < 0.05). The total exercise time increased by 11% on amlodipine compared with 2% on placebo, though this difference did not reach statistical significance. Angina attack frequency and nitroglycerin consumption were both reduced by adding amlodipine to beta-blocker treatment. Amlodipine in combination with beta-blocker therapy was well tolerated, with a low incidence of side effects and laboratory test abnormalities. The study showed clearly that addition of amlodipine to beta-blocker therapy in patients with stable angina pectoris was well tolerated and gave improved antianginal efficacy.     

An open multicenter efficacy and safety evaluation of amlodipine in the treatment of symptomatic myocardial ischemia

The efficacy and safety of amlodipine (5-10 mg) once daily were studied in an open study in patients with symptomatic myocardial ischemia. The study is ongoing and this report is based on an interim analysis of data from 78 patients. A 2-week baseline period in which patients maintained their current antianginal therapy was followed by a 10-week treatment period with 5-10 mg of amlodipine/day. Both the median number of angina attacks per week and the median number of nitroglycerin (NTG) tablets consumed/week were significantly reduced after amlodipine (mean daily dose of 8.6 mg) when compared with baseline (p < 0.05). A total of 98.4% of patients (63/64) experienced a reduction in the frequency of angina attacks/week and 91% of patients (58/64) had angina attacks reduced to < or = 2/week. In self-assessments, 95% of patients (55/58) reported improved angina control and 91% (53/58) felt their ability to perform usual activities had improved. Twenty-seven patients experienced adverse events reported as drug related. The most common adverse event noted was edema. Amlodipine once daily significantly reduced the incidence of angina attacks and the concomitant need of nitroglycerin for relief of symptoms and thus improved the patients' ability to perform daily activities. Most adverse events reported were mild or moderate and the incidence is as would be expected in this patient population.     

Bepridil. A review of its pharmacological properties and therapeutic use in stable angina pectoris.

Bepridil is a calcium antagonist with direct negative chronotropic, dromotropic, inotropic and vasodilatory actions which reduces myocardial oxygen consumption and increases coronary blood flow, leading to a significant anti-ischaemic and antianginal effect in the absence of reflex tachycardia. In contrast to other calcium channel blockers, bepridil produces only modest peripheral vasodilatation and displays weak antihypertensive activity. Its plasma elimination half-life of 1 to 2 days permits once daily administration. Results of short term clinical trials have shown bepridil to be of comparable efficacy to nifedipine, verapamil, diltiazem, propranolol and nadolol in decreasing the frequency of anginal attacks and consumption of nitroglycerin (glyceryl trinitrate) in patients with stable angina. Bepridil is more effective than nifedipine in improving exercise performance in patients with stable angina. Although bepridil proved superior to diltiazem in improving exercise performance in patients refractory to diltiazem, further studies are required to confirm the efficacy of bepridil in patients refractory to, or intolerant of, other antianginal agents. Bepridil in therapeutic doses is well tolerated, and appears to have a similar adverse effect profile to the established calcium antagonists. However, rate-dependent prolongation of the QTc interval and development of torsade de pointes have been associated with the use of bepridil. Therefore, bepridil is contraindicated in patients with hypokalaemia, those receiving other drugs that may prolong the QT interval, and those with congenital QT interval prolongation. Future clinical research will help to further define the position of bepridil as an antianginal treatment relative to the traditional calcium antagonists; in the interim, bepridil is indicated for the treatment of patients with angina refractory to or intolerant of other agents.     

左卡尼汀提高稳定型劳力性心绞痛病人运动耐量

目的 :比较左卡尼汀与曲美他嗪对心绞痛病人临床疗效及对运动耐量的影响。方法 :选择 6 0例冠心病稳定型心绞痛伴高脂血症病人 ,随机分为2组 ,分别予左卡尼汀 1.0 g ,po ,tid× 12wk及曲美他嗪 2 0mg ,po ,tid× 12wk ,比较每周心绞痛发作次数及硝酸甘油消耗量 ,运动耐量及血脂水平。结果 :左卡尼汀及曲美他嗪均减少心绞痛发作次数、硝酸甘油消耗量 ,运动至出现ST段压低 1mm所需时间、心绞痛所需时间、ST段缺血型下移之和明显减少 ,运动持续时间显著延长 ,左卡尼汀还降低总胆固醇、三酰甘油 ,升高高密度脂蛋白胆固醇。结论 :左卡尼汀及曲美他嗪均能缓解稳定型心绞痛病人症状 ,改善运动诱发的心肌缺血 ,提高运动耐量。左卡尼汀还可调节血脂水平     

Spotlight on Ranolazine in Chronic Stable Angina Pectoris

Ranolazine (Ranexa), a piperazine derivative, is a new antianginal agent approved for the treatment of chronic stable angina pectoris for use as combination therapy when angina is not adequately controlled with other antianginal agents. While the exact mechanism of action of ranolazine is not known, its antianginal and anti-ischemic effects do not appear to depend upon changes in BP or heart rate. An extended-release (ER) oral formulation of ranolazine has been developed to facilitate twice-daily administration whilst maintaining therapeutically effective plasma concentrations. In patients with chronic stable angina, ranolazine ER monotherapy was shown to improve exercise duration at trough plasma drug concentration in a dose-dependent manner compared with placebo. The drug was effective as adjunctive therapy in patients with chronic stable angina whose condition was not controlled adequately with conventional antianginal therapy. In randomized clinical trials, ranolazine ER was well tolerated, with no overt effects on cardiovascular hemodynamics or conduction, apart from a modest increase in corrected QT interval (but no torsades de pointes). Importantly, the efficacy and tolerability of ranolazine ER were not affected by old age and co-morbid conditions (heart failure or diabetes mellitus). Comparative trials of ranolazine ER with other antianginal agents and trials examining its effects on long-term morbidity and mortality in patients with ischemic heart disease are required to determine with greater certainty the place of the drug in current antianginal therapy. Nevertheless, ranolazine ER may well prove to be a useful alternative and adjunct to conventional hemodynamic antianginal therapy in the treatment of chronic stable angina.     

The role of trimetazidine after acute myocardial infarction

"Metabolic treatment" involves the use of drugs to improve cardiomyocyte function. Trimetazidine is the most investigated drugs in this group. The ESC 2006 guidelines on the management of patients with stable angina mention the efficacy of metabolic treatment in improving physical efficiency and decreasing the recurrence of pain. The available data suggest that combined therapy of trimetazidine and haemodynamic drugs is an effective antianginal treatment that reduces the risk of pain recurrence (in as many as 64% of patients). The most recent studies also suggest that trimetazidine might be effective in patients with acute coronary syndromes, ischemic cardiomyopathy and heart failure. However, while trimetazidine has shown beneficial effects on surrogate endpoints in several small trials its effect on cardiovascular events is uncertain. Further large randomized studies are needed before its effects on cardiovascular events can be evaluated.     

Systematic review on the short-term efficacy and safety of nicorandil for stable angina pectoris in comparison with those of β-blockers, nitrates and calcium antagonists

Nicorandil significantly reducted the incidence of major coronary events in patients with stable angina in a long-term trial, although there are few reports on its short-term efficacy in the treatment and prevention of angina symptoms. We performed a meta-analysis of the short-term efficacy of nicorandil compared with antianginal drugs for stable angina. We selected 20 reports (vs. β-blockers, n=6; vs. nitrates, n=6; vs. calcium antagonists, n=8) of prospective controlled trials from MEDLINE, the Cochrane Library, and Japana Centra Revuo Medicina. The trials were short in duration (median 5 weeks). We combined the results using odds ratios (OR) for discrete data and weighted mean differences (WMD) for continuous data. Compared with antianginal drugs, nicorandil did not show significant reduction of angina episodes per week (vs. β-blockers, -1.50 [95% confidence interval (CI): -4.09, 1.09]; vs. nitrates, 0.22 [95% CI: -1.22, 1.65]; vs. calcium antagonists, -0.23 [95% CI: -1.37, 0.90]). Furthermore, there were no significant differences in time to ischemia (total exercise duration, time to 1-mm ST depression, time to onset of pain). Although the total numbers of adverse events with each antianginal drug were similar, heart rate and blood pressure were significantly decreased by calcium antagonists but not changed by nicorandil (8.09 [95% CI: 3.20, 12.98] and 8.64 [95% CI: 3.28, 13.99], respectively). Thus this study suggests that short-term therapy with nicorandil is as effective as standard therapy and that nicorandil can also be used as a first-line agent in patients with stable angina.     

中国人群使用曲美他嗪治疗稳定型心绞痛疗效评价

目的系统评价曲美他嗪治疗稳定型心绞痛（stable angina pectoris,SAP）的临床疗效。方法2012年10月以曲美他嗪相关药品名称、口服制剂等做检索词,检索PubMed、Embase、Cochrane、中国生物医学文献数据库（CBM）、中国期刊全文专题数据库（CNKI）、中国科技期刊数据库（VIP）及万方数据库等,按纳入与排除标准选择文献并进行资料提取和质量评价后,采用Meta分析等统计学方法对曲美他嗪治疗稳定型心绞痛的疗效作系统评价。结果共纳入13个RCT,869例患者。Meta分析结果显示：在总有效率、每周心绞痛发作次数、每周硝酸甘油消耗量、sT段压低lmm阈值、心绞痛发作阈值5个方面,治疗组均明显优于对照组;而在运动持续时间方面,不支持曲美他嗪有增加患者运动持续时间的作用。结论曲美他嗪治疗稳定性心绞痛的疗效优于常规对照组,但因纳入的研究存在一定的方法学缺陷,本研究结论尚需进一步开展严格设计的大样本、多中心、随机双盲对照试验来证实。     

Comparison of nitroglycerin patches and nifedipine

Fifteen patients with stable angina participated in a 12-week crossover study to evaluate the efficacy of nifedipine and nitroglycerin patches. There was an initial 2-week drug washout period followed by a 2-week control period when patients received no other antianginal treatment other than sublingual nitroglycerin for relief of angina episodes. At the end of the 2-week control period, exercise performance was assessed with treadmill exercise testing and measurement of oxygen consumption during the final third of the dosing interval. Myocardial perfusion was assessed using thallium scintigraphy with the injection of thallium at 85% of the maximum oxygen consumption. Patients were then randomized to nifedipine or nitroglycerin patches, and the dosage was titrated at weekly intervals according to symptomatic response. The final dose was received for at least 2 weeks. After 4 weeks, patients received the alternate medication. Maximal exercise testing and thallium scintigraphy were repeated after each drug period. Both nifedipine (mean dose, 70 mg/day) and nitroglycerin patches (mean dose, 16 cm/day) significantly reduced the frequency of angina and the consumption of sublingual nitroglycerin. Nifedipine decreased the reversible thallium defect score (49 +/- 29 vs. 28 +/- 26 U, p less than 0.01). Both drugs reduced electrocardiographic evidence of myocardial ischemia at submaximal exercise. Maximal oxygen consumption was not significantly increased by either drug when the test was done during the latter part of the dosing interval. The clinical implications of this study are that the dosage of nifedipine and nitrate patches, based on symptomatic criteria of angina frequency reduction, may not result in objective improvement in exercise performance.