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Abstract
Silent myocardial ischemia, whether it occurs at rest or during exercise, is associated
with an unfavorable prognosis and may lead to sudden cardiac death. Agents used to
treat silent myocardial ischemia have included nitrates, beta-blockers, and calcium
antagonists (CAs). Despite treatment with traditional anti-ischemic agents, studies
have shown that up to 40% of patients who receive what is considered to be clinically
optimal antianginal therapy continue to have daily episodes of silent myocardial ischemia.
The use of nitrates and beta-blockers is sometimes confounded by issues of tolerance
and tolerability. Although the CAs have been found to be effective in decreasing the
duration and frequency of episodes of silent ischemia, in general beta-blockers produce
a greater reduction in these variables. Thus a need for effective and tolerable anti-ischemic
agents persists. A new class of CAs, the tetralol derivatives, may show promise in
this regard. The first of this new class, mibefradil, is characterized by selective
blockade of T-type calcium-ion channels and has been shown in a few studies to reduce
the frequency and duration of asymptomatic ischemic episodes in patients with stable
exertional angina pectoris. Large-scale clinical trials are necessary before the efficacy
and tolerability of this new CA can be compared fully with those of the beta-blockers
and currently available CAs.
Keywords
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© 1997 Published by Elsevier Inc.
