Background: The intravenous administration of heart rate-lowering calcium antagonists, such as verapamil and diltiazem, has proved to be effective in obtaining a prompt and steady reduction of myocardial oxygen consumption in patients with unstable angina. However, elderly patients can be particularly susceptible to the negative inotropic and dromotropic effects of these agents. Methods: In a randomized parallel-group study, we compared the effects of the verapamil derivative gallopamil (a bolus of 50 μg/kg followed by an infusion of 0.5-0.8 μg/kg/min) with those of diltiazem (a bolus of 0.1 mg/kg followed by an infusion of 2-5 μg/kg/min) in 39 patients aged over 70 years (median 77, range 70-87) with a diagnosis of unstable angina. All patients were treated with aspirin, heparin and nitrates during the run-in (24 h) and the randomized (48 h) treatment periods. Holter monitoring was performed throughout the study. Results: Both agents reduced the systolic blood pressure (P <0.0001 compared with baseline) and the heart rate (P <0.001 compared with baseline) to an equal extent in the first hour of infusion, a reduction that was maintained during the following 48 h. Diltiazem also reduced the diastolic blood pressure from baseline (P <0.01), whereas gallopamil had no effect. Only one patient experienced transient asymptomatic hypotension, and another developed first-degree atrioventricular block with gallopamil. None of the patients developed bradycardia or clinical signs of heart failure. During the 24 h run-in period, 10 episodes of ST-segment depression (177 min) were recorded using Holter monitoring in the group receiving gallopamil and 22 episodes (247 min) in those receiving diltiazem. During the 48 h of treatment, one episode (15 min) of ST-segment depression was recorded in the gallopamil group and 17 episodes (294 min) in the diltiazem group (P <0.05). Conclusion: Both gallopamil and diltiazem, when administered as a continuous intravenous infusion, reduced the heart rate and systolic blood pressure (and thus myocardial oxygen consumption) in elderly patients with unstable angina without producing adverse cardiac effects. The reduction in diastolic blood pressure observed with diltiazem, but not with gallopamil, might impair coronary perfusion in elderly patients. Patients treated with gallopamil had fewer episodes of ST-segment depression than those treated with diltiazem.
|Number of pages||6|
|Journal||Cardiology in the Elderly|
|Publication status||Published - 1995|
- unstable angina
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Geriatrics and Gerontology