Long-term efficacy of amlodipine in patients with severe coronary artery disease.
The long-term efficacy of amlodipine was assessed in 21 patients with chronic stable angina. After a 2-week run-in period, patients received 5 mg amlodipine once daily for 2 weeks. This was increased to 10 mg daily during the following 10-week dose-adjustment/maintenance phase, if angina attacks were not abolished. Patients were then followed up for an additional 21 months (total 24 months). During follow-up, patients were evaluated at least once a month, and sitting blood pressure and heart rate were monitored. Angina attack rate and nitroglycerin consumption were recorded in angina diaries throughout the study. Patients underwent a treadmill exercise test at baseline, at the end of the dose-adjustment phase and again during long-term follow-up at 20 months. Amlodipine (mean final daily dose, 8.2 mg) resulted in a significant reduction in angina attack rate and nitroglycerin consumption (both p < 0.001), which was maintained during follow-up. Systolic blood pressure was also reduced (p < 0.01) by amlodipine. Diastolic blood pressure and heart rate were not significantly affected. Amlodipine significantly increased mean exercise time (p < 0.001). ST-segment depression at maximum common load was reduced when compared with baseline values (p < 0.001), and the metabolic equivalent (MET) score at peak exercise was significantly improved by amlodipine (p < 0.001). All of these effects on exercise performance were sustained during follow-up. These data indicate that long-term treatment with amlodipine, in patients with severe coronary artery disease, reduced the number of angina attacks and nitroglycerin consumption and produced a sustained improvement in exercise performance.