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Efficacy of Ivabradine in Combination with Beta-Blocker Versus Uptitration of Beta-Blocker in Patients with Stable Angina
Cardiovascular Drugs and Therapy, 08/15/2011
Clinical Article
Amosova E et al. – These results suggest that combining ivabradine with low dose bisoprolol in stable angina patients produces additional antianginal and anti–ischemic benefits and improves chronotropic reserve.
Methods- Twenty–nine patients with stable angina and moderate left ventricular systolic dysfunction already on bisoprolol 5 mg od were randomized into 2 groups.
- Group 1 (n=17) received ivabradine (5–7.5 mg bid) in addition to bisoprolol 5 mg od, while in group 2 (n=12) bisoprolol was uptitrated first to 7.5 mg and then 10 mg od.
- Patients underwent a treadmill test, 6–minute walking test, and echocardiography at baseline and after 2 months.
- Mean resting heart rate decreased in both groups, from 76.6±4.6 bpm to 59.3±2.5 bpm (P<0.001) in group 1 and from 75.9±3.0 bpm to 60.5±2.3 bpm (P=0.002) in group 2.
- The effect on resting heart rate did not differ significantly between the two groups.
- However, more patients became asymptomatic in group 1 than in group 2.
- Addition of ivabradine also improved exercise capacity, as shown by the results of the 6–minute walking and exercise tolerance tests, whereas in group 2 neither parameter was significantly affected.
- Chronotropic reserve significantly improved with ivabradine, but not with bisoprolol 10 mg.