Summary
Trimetazidine has been shown to have an antianginal effect, increasing exercise capability without producing any significant change of heart rate or systolic blood pressure. The aim of this study was to compare trimetazidine efficiency to that of another classical antianginal drug. A double-blind crossover trimetazidine versus nifedipine trial was carried out in 39 male patients, mean age 58 years, with effort angina for 5 years on average, and a mean number of weekly attacks of 2.4. Thirteen patients had previous myocardial infarction. Nineteen patients received nifedipine (40 mg per day) then trimetazidine (60 mg per day), and 20 patients received the drugs in the opposite order. Each therapeutic period of 6 weeks was preceded by 1 week of washout with placebo. Drug efficacy was assessed by a bicycle exercise tolerance test, performed at the beginning and at the end of each therapeutic period, and by clinical symptoms observed with placebo or with treatment. The statistical analysis was performed according to a crossover design, with repeated measurements. The decrease of the number of weekly attacks was not significantly different with trimetazidine and nifedipine. Results on the exercise test showed no significant differences for maximum workload, the duration of exercise, ST-segment depression at peak exercise, and the time to 1-mm ST-segment depression. Heart rate and systolic blood pressure were not significantly different at rest and at peak exercise. However, the change in the rate-pressure product at the same workload differed significantly between the drugs: It decreased with nifedipine and remained unchanged with trimetazidine, indicating the difference to be in the mode of action of the drug. In conclusion, trimetazidine was as efficient as nifedipine in stable angina and had a lower incidence of side effects.
Similar content being viewed by others
References
Mosko Witz RM, Piccini PA, Nacarelli GV, et al. Nifedipine therapy for stable angina pectoris: Preliminary results of effects on angina frequency and treadmill exercise response. Am J Cardiol 1979;44:811–816.
Mueller HS, Chahine RA. Interim report of multicentre double-blind, placebo-controlled studies of nifedipine in chronic stable angina. Am J Med 1981;71:645–657.
Sellier P. Effets de la trimétazidine sur les paramètres ergométriques dans l'angor d'effort. Etude multicentrique contrôlée à double insu contre placebo. Arch Mal Coeur 1986;9:1331–1336.
Passeron J. Efficacy of trimetazidine in stable effort angina. Double-blind study against placebo. Presse Med 1986;15: 1775–1778.
Lavanchy N, Martin J, Rossi A. Anti-ischemic effects of trimetazidine: 31P-NMR spectroscopy in the isolated rat heart. Arch Intern Pharmacodyn Thér 1987;286:97–110.
Renaud JF. Internal pH, Na+ and Ca2+ regulation by trimetazidine during cardiac cell acidosis. Cardiovasc Drugs Ther 1988;1:677–686.
Cumming GR. The frequency and possible significance of “abnormal exercise ECG patterns in asymptomatic women.” In: Les épreuves d'effort. Paris: Expansion Scientifique 1978:13–43.
Winer BJ, Statistical principles in experimental design, New York: McGraw-Hill, 1971.
Timour Q, Goupit P, Lang J. Anti-anginal effects of trimetazidine: Mechanisms. Xth International Congress of Pharmacology, Sydney, Australia, August 23–28, 1987, abstracts, p. 648.
Sellier P., Maurice. Recherche des effets hémolynamiques de la trimétazidine, en administration unique chez l'homme. Thérapie 1987;42:245–246.
Sugimoto J, Nagata M, Fugono R et al. Strophantin-G toxicity and sodium ions. Jpn Circ J 1970;34:725–732.
Honoré E, Adamantidis MM, Challice CE, Dupuis BA. Cardioprotection by calcium antagonists, piridoxilate and trimetazidine. IRCS Med Sci 1986;14:938–939.
D'Alché P. Electrocardiographical assessment of trimetazidine antiischemic properties. Cardiovasc Drugs Ther 1990, in press.
Didier JP, Roux J, Violot D et al. Les effets de la trimétazidine sur le coeur isolé perfusé de rat en hypoxie: Étude hémodynamique et histologique. Gaz Med Fr 1984; 91(Suppl 26):28–34.
Harpey C, Labrid C, Baud L, et al. Evidence for antioxidant properties of trimetazidine. Xth International Congress of Pharmacology, Sydney, Australia, August 23–28, 1987, abstracts, p. 649.
Brochier M, Demange J, Duelous G, et al. Therapeutic value of a combination of trimetazidine and a calcium antagonist for the treatment of chronic artery disease. Controlled, double-blind study against placebo. Presse Med 1986;15:1783–1787.
Michaelides AP, Vysoulis GP, Bonoris PE, et al. Beneficial effects of trimetazidine in patients with stable angina under beta-blockers. Cardiovasc Drugs Ther 1987;1:268.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dalla-Volta, S., Maraglino, G., Della-Valentina, P. et al. Comparison of trimetazidine with nifedipine in effort angina: A double-blind, crossover study. Cardiovasc Drug Ther 4 (Suppl 4), 853–859 (1990). https://doi.org/10.1007/BF00051292
Issue Date:
DOI: https://doi.org/10.1007/BF00051292