Anti-ischaemic properties and tolerability of the calcium antagonist gallopamil were compared with those of nifedipine in a double-blind cross-over study performed in 20 patients affected by effort or mixed angina. The patients were of both sexes and aged 43-66 years; coronary angiography performed on 18 of them revealed at least one-vessel disease (stenosis > 70%). After a one week wash-out period the patients received placebo for 2 weeks; thereafter 10 patients were treated orally with gallopamil 150 mg daily and 10 patients with nifedipine 60 mg daily for 4 weeks. Before crossing-over to the alternate therapy a 2-week placebo period was allowed.The patients underwent cycloergometric exercise tests after each phase of treatment; workload was increased by 25 W every 3 min and the test was stopped in the presence of a typical angina or ST segment depression or age-predicted maximal heart rate.The results show that both exercise time and maximal workload were significantly increased by gallopamil and by nifedipine in comparison with placebo; also the maximal ST segment depression was significantly reduced by the two drugs.The number of patients developing angina and/or segment depression during exercise test was significantly reduced by both drugs compared to placebo. Time to onset of angina and time to ST depression ≥ 1 mm were increased, though not significantly, by both calcium antagonists.No side effects were recorded with gallopamil while with nifedipine six patients reported side effects. In conclusion, this cross-over study shows that gallopamil 150 mg daily has an anti-anginal efficacy comparable to that of nifedipine at high doses (60 mg daily), and as opposed to nifedipine, gallopamil is better tolerated. Gallopamil appears to be an effective and safe calcium-antagonist for the treatment of effort or mixed angina. © 1992 The European Society of Cardiology.
