Skip to main content
SpringerLink
Log in

Calcium Antagonists

Clinical Use in the Treatment of Angina

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Angina pectoris results from an imbalance between the oxygen supply and the oxygen needs of the myocardium. While the classic form of angina is usually caused by demands exceeding supply, a primary and transient decrease in coronary blood flow is more and more often recognised as an aetiological factor of myocardial ischaemia. Calcium antagonists, although new in cardiovascular therapeutics, are already recognised as the treatment of choice for some forms of angina and as useful therapeutic adjuncts in others. Few contraindications to their use exist. They are potent vasodilators and they can prevent the occurrence of coronary artery spasm responsible for the Prinzmetal’s variant form of angina. They can also reduce coronary artery tone, which if high, can compromise flow through a narrowed coronary artery.

Nifedipine, diltiazem and verapamil can also influence the various determinants of myocardial oxygen consumption to reduce myocardial oxygen needs. Their effects on heart rate, blood pressure and on the inotropic state of the left ventricle is, in vivo, the balance between their direct effects on the vascular wall and myocardial muscular cells and their indirect effects represented by the reflex physiological responses. Significant variations in these effects exist between the 3 calcium antagonists such that treatment can be individualised to a particular patient’s needs. Precautions with their use as well as most of their side effects can be understood from a knowledge of their direct and indirect properties.

Other pharmacological effects of these drugs include a regional redistribution of coronary blood flow, cardioprotection, delay in cell death and possibly in the progression of atherosclerosis. The clinical significance of these properties remains to be investigated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • André-Fouet, X.; Viallet, M.; Gayet, G; Thizy, J.F.; Wilner, G and Pont, M.: Diltiazem versus propranolol. A randomized trial in unstable angina (abstract). Circulation 64 (Suppl. IV): 293 (1981).

    Google Scholar 

  • Antman, E.; Muller, J.; Goldberg, S.; MacAlpin, R.; Rubenfire, M.; Tabatznik, B.; Liang, G; Heupier, F.; Achuff, S.; Reichek, N.; Geltman, E.; Kenn, N.A.; Neff, R.K. and Braunwald, E.: Nifedipine therapy for coronary-artery spasm. Experience in 127 patients. New England Journal of Medicine 302: 1269–1273 (1980a).

    Article  CAS  Google Scholar 

  • Antman, E.M.; Stone, P.H.; Muller, J.E. and Braunwald, E.: Calcium channel blocking agents in the treatment of cardiovascular disorders. Annals of Internal Medicine 93: 875–885 (1980b).

    PubMed  CAS  Google Scholar 

  • Antman, K. and Ryden, L.: Comparison of metoprolol and verapamil in the treatment of angina pectoris. American Journal of Cardiology 49: 821–827 (1982).

    Article  Google Scholar 

  • Bailey, I.K.; Griffith, L.S.C.; Rouleau, J.; Strauss, H.W. and Pitt, B.: Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease. Circulation 55: 79–87 (1977).

    Article  PubMed  CAS  Google Scholar 

  • Bentley, K.I. and Henry, P.D.: Anti-atherogenic effect of nifedipine in cholesterol-fed rabbit (abstract). Circulation 64 (Suppl. IV): (1981).

    Google Scholar 

  • Bertrand, M.E.; Lablanche, J.M. and Tilmant, P.Y.: Treatment of Prinzmetal’s variant angina. Role of medical treatment with nifedipine and surgical coronary revascularization combined with plexectomy. American Journal of Cardiology 47: 174–178 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Blumgart, H.; Schlesinger, M. and Davis, D.: Studies on the relation of the clinical manifestations of angina pectoris, coronary thrombosis, and myocardial infarction to the pathologic findings. American Heart Journal 19: 1–91 (1940).

    Article  Google Scholar 

  • Bory, M.; Franck, R.; Bénichou, M.; Egre, A.; Djiane, P. and Serradimigni, A.: Le test à l’ergométrine dans l’évaluation des thérapeutiques de l’angor spastique. Archives des Maladies du Coeur et des Vaisseaux 74: 901–907 (1981).

    PubMed  CAS  Google Scholar 

  • Bourassa, M.G.; Côté, P.; Théroux, P.; Tubau, J.F.; Genain, C. and Waters, D.D.: Hemodynamics and coronary flow following diltiazem administration in anesthetized dogs and in humans. Chest 78: 224–230 (1980).

    PubMed  CAS  Google Scholar 

  • Braunwald, E.: Control of myocardial oxygen consumption: Physiologic and clinical considerations. American Journal of Cardiology 27: 416–432 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Brown, B.G.; Bolson, E.; Petersen, R.B.; Pierce, C.D. and Dodge, H.T.: The mechanism of nitroglycerin action: Stenosis vasodilation as a major component of the drug response. Circulation 64: 1089–1097 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Carlens, P.: Effect of intravenous verapamil on exercise tolerance and left ventricular function in patients with severe exertional angina pectoris. J. Card. Pharm. 3: 1–10 (1981).

    Article  CAS  Google Scholar 

  • Dargie, H.J.; Lynch, P.G.; Krikler, D.M.; Harris, L. and Krikler, S.: Nifedipine and propranolol: A beneficial drug interaction. American Journal of Medicine 71: 676–682 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Debaisieux, J.C.; Théroux, P.; Waters, D.D. and Mizgala, H.F.: Hemodynamic effects of a single oral dose of nifedipine following acute myocardial infarction. Chest 78: 574–579 (1980).

    Article  PubMed  CAS  Google Scholar 

  • De Ponti, C.; Mauri, F.; Ciliberto, G.R. and Carù, B.: Comparative effects of nifedipine, verapamil, isosorbide dinitrate and propranolol on exercise-induced angina pectoris. European Journal of Cardiology 10: 47–58 (1979).

    PubMed  Google Scholar 

  • De Zwaan, C.; Bär, F.W.H.M. and Wellens, H.J.J.: Characteristic electrocardiographic pattern indicating a critical stenosis high in the left anterior descending coronary artery in patients admitted because of impending myocardial infarction. American Heart Journal 103: 730–736 (1981).

    Article  Google Scholar 

  • Dünschede, H.B. and Grundei, P.: Ergebnisse einer Feldstudie des koronartherapeutikums Adalat. Medizinische Welt 26: 1847 (1975).

    PubMed  Google Scholar 

  • Ekelund, L.G. and Orö, L.: Antianginal efficiency of nifedipine with and without a beta-blocker, studied with exercise test. A double blind, randomized subacute study. Clinical Cardiology 2: 203–211 (1979).

    PubMed  CAS  Google Scholar 

  • Epstein, S.E. and Talbot, T.L.: Dynamic coronary tone in precipitation, exacerbation and relief of angina pectoris. American Journal of Cardiology 48: 797–803 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Fleckenstein, A.; Tritthart, H.; Döring, H.J. and Byon, K.J.: Bay a 1040 — ein hockaktiver Ca++ — antagonistischer Inhibitor der elektro-mechanischen koppeiungsprozesse im Warmblüter-Myokard. Arzneimittel-Forschung 22: 22–23 (1972).

    PubMed  CAS  Google Scholar 

  • Folle, L.E.; Ortiz, A.; Artucio, R. and Dighiero, J.: Efficacy of Adalat in angina pectoris patients in controlled clinical trial compared with placebo; in Jatene et al. (Eds) New Therapy of Ischemic Heart Disease, pp.200–206 (Excerpta Medica, Amsterdam 1976).

    Google Scholar 

  • Freedman, B.; Dunn, R.F.; Richmond, D.R. and Kelly, D.T.: Coronary artery spasm during exercise: treatment with verapamil. Circulation 64: 68–75 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Freeman, W.R.; Peter, T. and Mandel, W.J.: Verapamil therapy in variant angina pectoris refractory to nitrates. American Heart Journal 102: 358–362 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Frishman, W.H.; Klein, N.A.; Strom, J.A.; Willens, H.; Lejemtel, Th.; Jentzer, J.; Siegel, L; Klein, P.; Kirschen, N.; Silverman, R.; Pollack, S.; Doyle, R.; Kirsten, E. and Sonnenblick, E.H.: Superiority of verapamil to propranolol in stable angina pectoris: A double-blind, randomized crossover trial. Circulation 65 (Suppl. I): 51–59 (1982).

    Google Scholar 

  • Ganz, W. and Marcus, H.S.: Failure of intracoronary nitroglycerin to alleviate pacing-induced angina. Circulation 46: 880–889 (1972).

    Article  PubMed  CAS  Google Scholar 

  • Gazes, P.C.; Mobley, E.M.; Faris, H.M.; Duncan, R.C. and Humphries, G.B.: Preinfarctional (unstable) angina — a prospective study. Ten year follow-up. Circulation 48: 331–337 (1973).

    CAS  Google Scholar 

  • Gerstenblith, G.; Ouyang, P.; Achuff, S.; Bulkley, B.; Becker, L.C.; Mellits, E.D.; Baughman, K.L.; Weiss, J.L.; Flaherty, J.T.; Kallman, C.H.; Llewellyn, M. and Weisfeldt, M.L.: Nifedipine in unstable angina. A double-blind randomized trial New England Journal of Medicine 306: 885–889 (1982).

    CAS  Google Scholar 

  • Girotti, L.A.; Crosatto, J.R.; Messuti, H.; Kaski, J.C.; Dyszel, E.; Rivas, C.A.; Araujo, L.I.; Vetulli, H.D. and Rosenbaum, M.B.: The hyperventilation test as a method for developing successful therapy in Prinzmetal’s angina. American Journal of Cardiology 49: 834–841 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Gould, K.L.; Lipscomb, K. and Hamilton, G.W.: Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. American Journal of Cardiology 33: 87–94 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Guazzi, M.; Magrini, F.; Fiorentini, C. and Polese, A.: Clinical, electrocardiographic, and haemodynamic effects of long-term use of propranolol in Prinzmetal’s variant angina pectoris. British Heart Journal 33: 889–894 (1971).

    Article  PubMed  CAS  Google Scholar 

  • Heberden, W.: Some account of a disorder of the heart. Medical Transactions, Royal College of Physicians 2: 59 (1768).

    Google Scholar 

  • Hill, J.A.; Feldman, R.L.; Pepine, C.J. and Conti, R.C.: Randomized double-blind comparison of nifedipine and isosorbide dinitrate in patients with coronary arterial spasm. American Journal of Cardiology 49: 431–438 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Holmes Jr, D.R.; Hartzler, G.O.; Smith, H.G. and Fuster, V.: Coronary artery thrombosis in patients with unstable angina. British Heart Journal 45: 411–416 (1981).

    Article  PubMed  Google Scholar 

  • Hossack, K.F. and Bruce, R.A.: Improved exercise performance in persons with stable angina pectoris receiving diltiazem. American Journal of Cardiology 47: 95–101 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Hugenholtz, P.G.; Michels, H.R.; Serruys, P.W. and Brower, R.W.: Nifedipine in the treatment of unstable angina, coronary spasm and myocardial ischemia. American Journal of Cardiology 47: 163–173 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, S.M.; Mauritson, D.R.; Willerson, J.T.; Hillis, L.D.; Erck, B.J. and Brown, S.B.: Comparison of verapamil and nifedipine in the treatment of variant angina pectoris: Preliminary observations in 10 patients. American Journal of Cardiology 47: 1295–1300 (1981a).

    Article  PubMed  CAS  Google Scholar 

  • Johnson, S.M.; Mauritson, D.R.; Willerson, J.T. and Hillis, L.D.: A controlled trial of verapamil for Prinzmetal’s variant angina. New England Journal of Medicine 304: 862–866 (1981b).

    Article  PubMed  CAS  Google Scholar 

  • Kimura, E. and Kishida, H.: Treatment of variant angina with drugs: A survey of 11 cardiology institutes in Japan. Circulation 63: 844–848 (1981).

    Article  PubMed  CAS  Google Scholar 

  • King, M.J.; Zir, L.M.; Kaltman, A.J. and Fox, A.C.: Variant angina associated with angiographically demonstrated coronary artery spasm and REM sleep. American Journal of Medical Sciences 265: 419–422 (1973).

    Article  CAS  Google Scholar 

  • Kinoshita, M.; Motomura, M.; Kusukawa, R. and Kawakita, S.: Comparison of hemodynamic effects between β-blocking agents and a new antianginal agent, diltiazem hydrochloride. Japanese Circulation Journal 43: 587–598 (1979).

    Article  CAS  Google Scholar 

  • Klein, H.O.; Lang, R.; Weiss, E.; Di Segni, E.; Libhaber, C.; Guerrero, J. and Kaplinsky, E.: The influence of verapamil on serum digoxin concentration. Circulation 65: 998–1003 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Koiwaya, Y.; Nakamura, M; Mitsutake, A.; Tanaka, S. and Takeshita, A.: Increased exercise tolerance after oral diltiazem, a calcium antagonist, in angina pectoris. American Heart Journal 101: 143–149 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Lichtlen, P.; Engel, HJ.; Amende, I.; Rafflenbeul, W. and Simon, R.: Mechanism of various antianginal drugs. Relationship between regional flow behaviour and contractility; in Jatene et al. (Eds) 3rd International Adalat Symposium, Amsterdam, pp. 14–32 (Excerpta Medica, Amsterdam 1976).

    Google Scholar 

  • Livesley, B.; Catley, P.F.; Campbell, R.C. and Oram, S.: Double-blind evaluation of verapamil, propranolol and isosorbide dinitrate against a placebo in the treatment of angina pectoris. British Medical Journal 1: 375–378 (1973).

    Article  PubMed  CAS  Google Scholar 

  • MacAlpin, R.N.: Correlation of the location of coronary arterial spasm with the lead distribution of ST segment elevation during angina pectoris. American Heart Journal 99: 555–564 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Mansen, J.F. and Sandoe, E.: Treatment of Prinzmetal’s angina due to coronary artery spasm using verapamil: A report of three cases. European Journal of Cardiology 7: 327–335 (1978).

    Google Scholar 

  • Maseri, A.; Parodi, O.; Severi, S. and Pesola, A.: Transient transmural reduction of myocardial blood flow, demonstrated by thallium-201 scintigraphy, as a cause of variant angina. Circulation 54: 280–288 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Maseri, A.; Severi, S.; DeNes, M.; L’Abbate, A.; Chierchia, S.; Marzilli, M.; Ballestra, A.M.; Parodi, O.; Biagini, A. and Distante, D.: Variant angina: One aspect of a continuous spectrum of vasospastic myocardial ischemia. American Journal of Cardiology 42: 1019–1035 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Mizuno, Y.; Yasui, S.; Sotohata, I.; Nukagawa, K.; Hashimoto, Y.; Nagaya, A.; Nonokawa, A.; Horiba, Y.; Aihara, N.; Tsuchiya, T.; Ishikawa, K.; Ooishi, I.T.; Uchiyama, O.; Kuwahara, M. and Kashiwagi, C.: The effect of CRD-401 on ischemic heart disease. Double blind study. Japanese Journal of Clinical and Experimental Medicine (in Japanese) 50: 565 (1973).

    Google Scholar 

  • Moskowitz, R.M.; Piccini, P.A.; Nacarelli, G.V. and Zelis, R.: Nifedipine therapy for stable angina pectoris: Preliminary results of effects on angina frequency and treadmill exercise response. American Journal of Cardiology 44: 811–816 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Mueller, H.S. and Chahine, R.A.: Interim report of multicenter double-blind placebo-controlled studies of nifedipine in chronic stable angina. Am. J. Med. 71: 645–657 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Mulcahy, R.; Daly, L.; Graham, I.; Hickey, N.; O’Donoghue, S.; Owens, A.; Ruane, P. and Tobin, G.: Unstable angina: Natural history and determinants of prognosis. American Journal of Cardiology 48: 525–528 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Neumann, M. and Luisada, A.A.: Double-blind evaluation of orally administered iproveratril in patients with angina pectoris. American Journal of Medical Sciences 251: 552–556 (1966).

    Article  CAS  Google Scholar 

  • Parodi, O.; Maseri, A. and Simonetti, I.: Management of unstable angina at rest by verapamil. A double-blind cross-over study in coronary care unit. British Heart Journal 41: 167–174 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Pempree, A. and Tabatznik, B.: Influence of different doses of nifedipine on angina pectoris induced by exercise; in Jatene et al. (Eds) New Therapy of Ischemic Heart Disease, pp. 113–118 (Excerpta Medica, Amsterdam 1976).

    Google Scholar 

  • Pepine, C.J.; Feldman, R.L.; Whittle, J.; Curry, R.C. and Conti, C.R.: Effect of diltiazem in patients with variant angina: A randomized double-blind trial. American Heart Journal 101: 719–725 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Pfisterer, M.; Müller-Brand, J. and Burkart, F.: Combined acebutolol/nifedipine therapy in patients with chronic coronary artery disease: Additional improvement of ischemia-induced left ventricular dysfunction. American Journal of Cardiology 49: 1259–1268 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Pine, M.B.; Citron, P.D.; Bailly, D.J.; Butman, S.; Plasencia, G.O.; Landa, D.W. and Wong, R.K.: Verapamil versus placebo in relieving stable angina pectoris. Circulation 65: 17–22 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Pool, P.E. and Seagren, S.C.: Long-term efficacy of diltiazem in chronic stable angina associated with atherosclerosis: Effect on treadmill exercise. American Journal of Cardiology 49: 573–577 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Previtali, M.; Salerno, J.A.; Tavazzi, L.; Ray, M.; Medici, A.; Chimienti, M.; Specchia, G. and Bobba, P.: Treatment of angina at rest with nifedipine: A short-term controlled study. American Journal of Cardiology 45: 825–830 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Prinzmetal, M.; Kennamer, R.; Merliss, R.; Wada, T. and Bor, N.: Angina pectoris. I. A variant form of angina pectoris. American Journal of Medicine 27: 375–388 (1959).

    CAS  Google Scholar 

  • Robertson, R.M.; Wood, A.J.J.; Vaughn, W.K. and Robertson, D.: Exacerbation of vasotonic angina pectoris by propranolol. Circulation 65: 281–285 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Rosenthal, S.J.; Ginsberg, R.; Lamb, I.H.; Bairn, D.S. and Schroeder, J.S.: Efficacy of diltiazem for control of symptoms of coronary arterial spasm. American Journal of Cardiology 46: 1027–1032 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Sandler, G.; Clayton, G.A. and Thornicroft, S.G.: Clinical evaluation of verapamil in angina pectoris. British Medical Journal 3: 224 (1968).

    Article  PubMed  CAS  Google Scholar 

  • Selzer, A.; Langstron, M; Ruggeroli, C. and Cohn, K.: Clinical syndrome of variant angina with normal coronary arteriogram. New England Journal of Medicine 295: 1343–1347 (1976).

    Article  PubMed  CAS  Google Scholar 

  • Severi, S.; Davies, A.; Maseri, A.; Marzullo, P. and L’Abbate, A.: Long-term prognosis of ‘variant’ angina with medical treatment. American Journal of Cardiology 46: 226–232 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Sobel, M.; Salzman, E.W. and Davies, G.C.: Circulating platelet products in unstable angina pectoris. Circulation 63: 300–306 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Solberg, L.E.; Nissen, R.G.; Vliestra, R.E. and Callahan, J.A.: Prinzmetal’s variant angina-response to verapamil. Mayo Clinic Proceedings 53: 256–259 (1978).

    PubMed  CAS  Google Scholar 

  • Specchia, G.; DeServi, S.; Falcone, C.; Angoli, L.; Mussini, A.; Bramucci, E.; Marioni, G.P.; Ardissino, D.; Salerno, J. and Bobba, P.: Significance of exercise-induced ST-segment elevation in patients without myocardial infarction. Circulation 63: 46–53 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Strauss, W.E.; McIntyre, K.M.; Parisi, A.F. and Shapiro, W.: Safety and efficacy of diltiazem hydrochloride for the treatment of stable angina pectoris: Report of a cooperative clinical trial. American Journal of Cardiology 49: 560–566 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Subramanian, B.; Bowles, M.; Iahiri, A.; Davies, A.B. and Raftery, E.B.: Long term antianginal action of verapamil assessed by quantitated serial treadmill exercise test. American Journal of Cardiology 48: 529–535 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Subramanian, B.; Bowles, M.J.; Davies, A.B. and Raftery, E.B.: Combined therapy with verapamil and propranolol in chronic stable angina. Am. J. Card. 49: 125–132 (1981a).

    Article  Google Scholar 

  • Subramanian, U.B.; Bowles, M.J.; Khurmi, N.S.; Davies, A.B. and Raftery, A.B.: Comparison of the antianginal efficacy of four calcium ion antagonists with propranolol (abstract). American Journal of Cardiology 49: 929 (1982b).

    Article  Google Scholar 

  • Taeymans, Y.; Moise, A.; Théroux, P.; Descoings, B.; Lespérance, J.; Waters, D.D. and Bourassa, M.G.: Unstable angina pectoris as an indicator of a progression of coronary artery disease. Circulation. (In press, 1982a).

    Google Scholar 

  • Taeymans, Y.; Théroux, P.; Waters, D.D.; Szlachcic, J. and Pelletier, G.B.: A prospective randomized study of propranolol versus diltiazem in patients with unstable angina (abstract). American Journal of Cardiology 49: 896 (1982b).

    Article  Google Scholar 

  • Tan, A.T.H.; Sadick, N.; Harris, P.J.; Freedman, S.B. and Bautovich, G.: Verapamil in stable effort angina: effects on left ventricular function evaluated with exercise radionuclide ventriculography. American Journal of Cardiology 49: 425–430 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Théroux, P.; Franklin, D. and Ross Jr, J.: Regional myocardial function during acute coronary occlusion and its modification by pharmacologic agent in the dog. Circulation Research 35: 896–908 (1974).

    Article  PubMed  Google Scholar 

  • Théroux, P.; Waters, D.D.; Debaisieux, J.C.; Szlachcic, J.; Mizgala, H.F. and Bourassa, M.G.: Hemodynamic effects of calcium ion antagonists after an acute myocardial infarction. Clinical and Investigative Medicine 3: 81–85 (1980).

    PubMed  Google Scholar 

  • Théroux, P. and Waters, D.D.: Calcium flux inhibition in the therapy of vasospastic angina; in Antman (Ed) Calcium Flux Inhibition (In press, 1982).

    Google Scholar 

  • Tiefenbrunn, R.J.; Sobel, B.E.; Gowka, S.; McKnight, R.C. and Ludbrook, P.A.: Nifedipine blockade of ergonovine-induced coronary arterial spasm: angiographic documentation. American Journal of Cardiology 48: 184–187 (1981).

    Article  PubMed  CAS  Google Scholar 

  • Tilmant, P.Y.; Lablanche, J.M.; Thieuleux, F.P.; Dupuis, B.A. and Bertrand, M.E.: Comparison of beta-blockers and calcium antagonists in the treatment of patients with coronary artery spasm (abstract). American Journal of Cardiology 49: 976 (1982).

    Article  Google Scholar 

  • Wagniart, P.; Ferguson, R.J.; Chaitman, B.R.; Achard, F.; Benacerraf, A.; Delanguenhagen, B.; Morin, B.; Pasternac, A. and Bourassa, M.G.: Increased exercise tolerance and reduced electrocardiographic ischemia with diltiazem in patients with stable angina pectoris. Circulation 66: 23–28 (1982).

    Article  PubMed  CAS  Google Scholar 

  • Waters, D.D.; Théroux, P.; Szlachcic, J.; Dauwe, F.; Crittin, J.; Bonan, R. and Mizgala, H.F.: Ergonovine testing in a coronary care unit. American Journal of Cardiology 46: 922–930 (1980).

    Article  PubMed  CAS  Google Scholar 

  • Waters, D.D.; Théroux, P.; Szlachcic, J. and Dauwe, F.: Provocative testing with ergonovine to assess the efficacy of treatment with nifedipine, diltiazem and verapamil in variant angina. American Journal of Cardiology 48: 123–130 (1981a).

    Article  PubMed  CAS  Google Scholar 

  • Waters, D.D.; Szlachcic, J.; Théroux, P.; Dauwe, F. and Mizgala, H.F.: Ergonovine testing to detect spontaneous remissions of variant angina during long-term treatment with calcium antagonist drugs. American Journal of Cardiology 47: 179–184 (1981b).

    Article  PubMed  CAS  Google Scholar 

  • Waters, D.D.; Szlachcic, J.; Bourassa, M.G.; Scholl, J.M. and Théroux, P.: Exercise testing in patients with variant angina: Results, correlation with clinical and angiographic features and prognostic significance. Circulation 65: 265–274 (1982a).

    Article  PubMed  CAS  Google Scholar 

  • Waters, D.D.; Szlachcic, J.; Miller, D. and Théroux, P.: Clinical characteristics of patients with variant angina complicated by myocardial infarction or death within 1 month. American Journal of Cardiology 49: 658–664 (1982b).

    Article  PubMed  CAS  Google Scholar 

  • Weber, S.; Pasquier, G.; Guiomard, A.; Lancelin, B.; Maurice, P.; Gourgon, R. and Degeorges, M.: Application clinique du test de provocation par l’alcalose du spasme artériel coronaire. Archives des Maladies du Coeur et des Vaisseaux 74: 1389–1395 (1981).

    PubMed  CAS  Google Scholar 

  • Yasue, H.; Touyama, M.; Shimamoto, M.; Kato, H.; Tanaka, S. and Akiyama, F.: Role of autonomic nervous system in the pathogenesis of Prinzmetal’s variant form of angina. Circulation 50: 534–539 (1974).

    Article  PubMed  CAS  Google Scholar 

  • Yasue, H.; Nagao, M.; Omote, S.; Takizawa, A.; Miwa, K. and Tanaka, S.: Coronary arterial spasm and Prinzmetal’s variant form of angina induced by hyperventilation and Tris buffer infusion. Circulation 58: 56–62 (1978).

    Article  PubMed  CAS  Google Scholar 

  • Yasue, H.; Omote, S.; Takizawa, A.; Nagao, M.; Miwa, K. and Tanaka, S.: Circadian variation of exercise capacity in patients with Prinzmetal’s variant angina: Role of exercise-induced coronary arterial spasm. Circulation 59: 938–948 (1979).

    Article  PubMed  CAS  Google Scholar 

  • Yasue, H.: Pathophysiology and treatment of coronary arterial spasm. Chest 78: 216–223 (1980).

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Montreal Heart Institute, 5000 East, Belanger Street, Montreal, Quebec, HIT IC8, Canada

    Pierre Théroux, Yves Taeymans & David D. Waters

Authors
  1. Pierre Théroux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yves Taeymans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David D. Waters
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Théroux, P., Taeymans, Y. & Waters, D.D. Calcium Antagonists. Drugs 25, 178–195 (1983). https://doi.org/10.2165/00003495-198325020-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-198325020-00005

Keywords

Search

Navigation