Which drug to choose for stable angina pectoris: a comparative study between bisoprolol and nitrates

• Published in: International journal of cardiology 1995-01, Vol.47 (3), p.217-223
• Main Authors: van de Ven, L.L.M., Vermeulen, A., Tans, J.G.M., Tans, A.C., Liem, K.L., Lageweg, N.C., Lie, K.I.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angina pectoris; Angina Pectoris - drug therapy; Angina Pectoris - physiopathology; Antianginal agents. Coronary vasodilator agents; Beta-blockers; Biological and medical sciences; Bisoprolol - administration & dosage; Bisoprolol - adverse effects; Bisoprolol - therapeutic use; Blood Pressure; Cardiovascular system; Cross-Over Studies; Double-Blind Method; Drug Administration Schedule; Exercise Test; Female; Heart Rate; Humans; Isosorbide Dinitrate - administration & dosage; Isosorbide Dinitrate - adverse effects; Isosorbide Dinitrate - therapeutic use; Male; Medical sciences; Middle Aged; Nitrates; Nitroglycerin - administration & dosage; Nitroglycerin - therapeutic use; Pharmacology. Drug treatments; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/0167-5273(94)02194-N

The choice between β-blockade or nitrates as first line treatment for stable angina pectoris is based upon the different mechanisms of action and patient characteristics. We performed a clinical trial comparing the efficacy of the longacting β-blocker bisoprolol once daily and the short acting nitrate, isosorbide dinitrate, three times daily in the reduction of anginal complaints in daily life and under stress. Thirty patients were enrolled in a double-blind randomised cross-over study. Both bisoprolol and isosorbide dinitrate were effective in reducing anginal attacks and nitroglycerin consumption significantly, but bisoprolol was significantly more effective than isosorbide dinitrate. Bisoprolol improved the workload during bicycle exercise testing significantly, but the improvement with isosorbide dinitrate was not significant. Despite the reduction in maximal rate pressure product, bisoprolol was significantly ( P < 0.05) more effective at improving total workload and reducing the time to onset of angina than isosorbide dinitrate. The rate pressure product did not change significantly with isosorbide dinitrate. In this study, bisoprolol 10 mg once daily was more effective and caused less side effects than isosorbide dinitrate 20 mg three times a day. It seems questionable if monotherapy of isosorbide dinitrate 20 mg t.i.d is an adequate drug regime for stable angina pectoris.