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Efficacy and safety of carvedilol in comparison with nifedipine sustained-release in chronic stable angina.

In patients with chronic stable exertional angina pectoris, the antianginal and anti-ischemic efficacies and the safety of 25 mg carvedilol b.i.d. were compared with those of 20 mg nifedipine sustained-release (SR) in a double-blind, randomized, multicenter study. In 22 centers, 166 patients were enrolled. After washout and run-in phases with two symptom-limited seated bicycle exercise tests on placebo, eligible patients were allocated to one of the two parallel treatment groups. After 4 weeks of active treatment, an additional exercise test was performed 12 h after the preceding dose. The patients were issued diary cards to document the daily number of anginal attacks and glyceryl trinitrate applications. Symptom-limited total exercise time, time to onset of angina, and time to 1-mm ST-segment depression increased with both treatments vs. placebo baseline values. The changes were more distinct in the carvedilol group, but the between-group differences were not statistically significant. Angina symptomatology during daily life and glyceryl trinitrate consumption were markedly improved by each treatment. Adverse events on treatment, particularly those correlated to vasodilation, were less frequent in the carvedilol group.