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Drug Treatment of Stable Angina Pectoris in the Elderly

Defining the Place of Calcium Channel Antagonists

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Abstract

Chronic stable angina pectoris (CSAP) resulting from coronary artery disease (CAD) is common in elderly patients, and significantly reduces their quality of life. Myocardial revascularisation procedures in this age group entail significant risks, largely related to comorbidities rather than advanced age itself. Coronary artery anatomy is more likely to be technically unsuitable for revascularisation and angina more resistant to drug treatment. Therefore, elderly patients often take combinations of antianginal drugs. Calcium channel antagonists (CCAs) are effective antianginal drugs first introduced for clinical use in the late 1970’s. They reduce myocardial ischaemia by both causing vasodilatation of coronary resistance vessels and reducing cardiac workload (negative inotropic effect). However, adverse effects related to abrupt arterial vasodilatation limited the tolerability of these short acting ‘first generation’ drugs (nifedipine, verapamil and diltiazem). Furthermore, short acting nifedipine may occasionally increase both the frequency of angina pectoris and mortality in patients with CAD. Since then, long acting formulations of first generation agents and new chemical entities (second and third generation drugs) have been developed. These are well tolerated and effective at attenuating both myocardial ischaemia and the frequency and severity of angina pectoris in most patients with stable CAD.

Current guidelines on the drug treatment of CSAP propose that β-adrenoceptor antagonists (β-blockers) should be used as first line medication primarily for their prognostic benefits, and that CCAs need only be introduced if β-blockers are not tolerated, contraindicated or ineffective. Despite this, there is a wealth of evidence from clinical trials that demonstrate equal antianginal efficacy for CCAs and β-blockers. The presence of chronic heart failure and prior myocardial infarction are clear indications for the use of β-blockers in preference to CCAs for the treatment of CSAP. However, in patients with both CSAP and hypertension, second and third generation CCAs may offer prognostic benefits of similar magnitude to those provided by β-blockers. Therefore, antianginal drug therapy must be tailored to the individual needs and comorbidities of each elderly patient.

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References

  1. Wenger NK, O’Rourke RA, Marcus FI. The care of elderly patients with cardiovascular disease. Ann Intern Med 1988; 109(5): 425–8

    PubMed  CAS  Google Scholar 

  2. Simons LA. Epidemiologic considerations in cardiovascular diseases in the elderly: international comparisons and trends. Am J Cardiol 1989; 63(16): 5H–8H

    Article  PubMed  CAS  Google Scholar 

  3. Fleg JL, Gerstenblith G, Zonderman AB, et al. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia detected by thallium scintigraphy and electrocardiography in asymptomatic volunteers. Circulation 1990; 81(2): 428–36

    Article  PubMed  CAS  Google Scholar 

  4. Rihal CS, Gersh BJ, Yusuf S. Chronic coronary artery disease: coronary artery bypass surgery versus percutaneous transluminal coronary angioplasty versus medical. In: Yusuf S, Cairns JA, Camm AJ, Fallen EL, Gersh BJ, editors. Evidence based cardiology. London: BMJ Books, 1999: 368–92

    Google Scholar 

  5. Luscher TF, Cosentino F. The classification of calcium antagonists and their selection in the treatment of hypertension: a reappraisal. Drugs 1998; 55(4): 509–17

    Article  PubMed  CAS  Google Scholar 

  6. Toyo-Oka T, Nayler WG. Third generation calcium entry blockers. Blood Press 1996; 5(4): 206–8

    Article  PubMed  CAS  Google Scholar 

  7. Leenen FH. Clinical relevance of 24h blood pressure control by 1,4-dihydropyridines. Am J Hypertens 1996; 9 (10 Pt 2): 97S–104S

    PubMed  CAS  Google Scholar 

  8. Purcell H, Waller DG, Fox K. Calcium antagonists in cardiovascular disease. Br J Clin Pract 1989; 43(10): 369–79

    PubMed  CAS  Google Scholar 

  9. Wenzel RR, Allegranza G, Binggeli C, et al. Differential activation of cardiac and peripheral sympathetic nervous system by nifedipine: role of pharmacokinetics. J Am Coll Cardiol 1997; 29(7): 1607–14

    Article  PubMed  CAS  Google Scholar 

  10. Furberg CD, Pahor M, Psaty BM. The unnecessary controversy. Eur Heart J 1996; 17(8): 1142–7

    Article  PubMed  CAS  Google Scholar 

  11. Littler WA, Sheridan DJ. Placebo controlled trial of felodipine in patients with mild to moderate heart failure: UK Study Group. Br Heart J 1995; 73(5): 428–33

    Article  PubMed  CAS  Google Scholar 

  12. Dougall HT, McLay J. A comparative review of the adverse effects of calcium antagonists. Drug Saf 1996; 15(2): 91–106

    Article  PubMed  CAS  Google Scholar 

  13. Packer M, O’Connor CM, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure: Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med 1996; 335(15): 1107–14

    Article  PubMed  CAS  Google Scholar 

  14. Schwartz A. Molecular and cellular aspects of calcium channel antagonism. Am J Cardiol 1992; 70(16): 6F–8F

    Article  PubMed  CAS  Google Scholar 

  15. Fleckenstein A. Specific pharmacology of calcium in myocardium, cardiac pacemakers, and vascular smooth muscle. Annu Rev Pharmacol Toxicol 1977; 17: 149–66

    Article  PubMed  CAS  Google Scholar 

  16. Kojda G, Klaus W, Werner G, et al. Reduced responses of nitrendipine in PGF2 alpha-precontracted porcine isolated arteries after pretreatment with methylene blue. Basic Res Cardiol 1990; 85(5): 461–6

    Article  PubMed  CAS  Google Scholar 

  17. Gunther J, Dhein S, Rosen R, et al. Nitric oxide (EDRF) enhances the vasorelaxing effect of nitrendipine in various isolated arteries. Basic Res Cardiol 1992; 87(5): 452–60

    PubMed  CAS  Google Scholar 

  18. Zhang X, Hintze TH. Amlodipine releases nitric oxide from canine coronary microvessels: an unexpected mechanism of action of a calcium channel-blocking agent. Circulation 1998; 97(6): 576–80

    Article  PubMed  CAS  Google Scholar 

  19. Tanguay M, Jasmin G, Blaise G, et al. Coronary and cardiac sensitivity to the vasoselective benzothiazepine-like calcium antagonist, clentiazem, in experimental heart failure. Cardiovasc Drugs Ther 1997; 11(1): 71–9

    Article  PubMed  CAS  Google Scholar 

  20. Dhein S, Salameh A, Berkels R, et al. Dual mode of action of dihydropyridine calcium antagonists: a role for nitric oxide. Drugs 1999; 58(3): 397–404

    Article  PubMed  CAS  Google Scholar 

  21. John S, Schmieder RE. Impaired endothelial function in arterial hypertension and hypercholesterolemia: potential mechanisms and differences. J Hypertens 2000; 18(4): 363–74

    Article  PubMed  CAS  Google Scholar 

  22. Calles-Escandon J, Cipolla M. Diabetes and endothelial dysfunction: a clinical perspective. Endocr Rev 2001; 22(1): 36–52

    Article  PubMed  CAS  Google Scholar 

  23. Puddu P, Puddu GM, Zaca F, et al. Endothelial dysfunction in hypertension. Acta Cardiol 2000; 55(4): 221–32

    Article  PubMed  CAS  Google Scholar 

  24. Barua RS, Ambrose JA, Eales-Reynolds LJ, et al. Dysfunctional endothelial nitric oxide biosynthesis in healthy smokers with impaired endothelium-dependent vasodilatation. Circulation 2001; 104(16): 1905–10

    Article  PubMed  CAS  Google Scholar 

  25. Lichtlen PR, Hugenholtz PG, Rafflenbeul W, et al. Retardation of angiographic progression of coronary artery disease by nifedipine: results of the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT). INTACT Group Investigators. Lancet 1990; 335(8698): 1109–13

    Article  PubMed  CAS  Google Scholar 

  26. Waters D, Lesperance J, Francetich M, et al. A controlled clinical trial to assess the effect of a calcium channel blocker on the progression of coronary atherosclerosis. Circulation 1990; 82(6): 1940–53

    Article  PubMed  CAS  Google Scholar 

  27. Borhani NO, Mercuri M, Borhani PA, et al. Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS): a randomized controlled trial. JAMA 1996; 276(10): 785–91

    Article  PubMed  CAS  Google Scholar 

  28. Jorgensen B, Simonsen S, Endresen K, et al. Restenosis and clinical outcome in patients treated with amlodipine after angioplasty: results from the Coronary AngioPlasty Amlodipine REStenosis Study (CAPARES). J Am Coll Cardiol 2000; 35(3): 592–9

    Article  PubMed  CAS  Google Scholar 

  29. Tison P, Ulicna L, Jakubovska Z, et al. Effects of dihydropyridines and their combination with aspirin on blood pressure and circadian platelet activity in patients with essential hypertension. Am J Hypertens 1994; 7 (7 Pt 2): 46S–9S

    PubMed  CAS  Google Scholar 

  30. Berkels R, Klaus W, Boiler M, et al. The calcium modulator nifedipine exerts its antiaggregatory property via a nitric oxide mediated process. Thromb Haemost 1994; 72(2): 309–12

    PubMed  CAS  Google Scholar 

  31. Rinaldi CA, Linka AZ, Masani ND, et al. Randomized, doubleblind crossover study to investigate the effects of amlodipine and isosorbide mononitrate on the time course and severity of exercise-induced myocardial stunning. Circulation 1998; 98(8): 749–56

    Article  PubMed  CAS  Google Scholar 

  32. Ardissino D, Savonitto S, Egstrup K, et al. Selection of medical treatment in stable angina pectoris: results of the International Multicenter Angina Exercise (IMAGE) Study. J Am Coll Cardiol 1995; 25(7): 1516–21

    Article  PubMed  CAS  Google Scholar 

  33. Crake T, Mulcahy D, Wright C, et al. Labetalol in the treatment of stable exertional angina pectoris: a comparison with nifedipine. Eur Heart J 1988; 9(11): 1200–5

    PubMed  CAS  Google Scholar 

  34. Di Somma S, de Divitiis M, Bertocchi F, et al. Treatment of hypertension associated with stable angina pectoris: favourable interaction between new metoprolol formulation (OROS) and nifedipine. Cardiologia 1996; 41(7): 635–43

    PubMed  Google Scholar 

  35. Findlay IN, MacLeod K, Ford M, et al. Treatment of angina pectoris with nifedipine and atenolol: efficacy and effect on cardiac function. Br Heart J 1986; 55(3): 240–5

    Article  PubMed  CAS  Google Scholar 

  36. Kawanishi DT, Reid CL, Morrison EC, et al. Response of angina and ischemia to long-term treatment in patients with chronic stable angina: a double-blind randomized individualized dosing trial of nifedipine, propranolol and their combination. J Am Coll Cardiol 1992; 19(2): 409–17

    Article  PubMed  CAS  Google Scholar 

  37. Savonitto S, Ardissiono D, Egstrup K, et al. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris: results of the International Multicenter Angina Exercise (IMAGE) Study. J Am Coll Cardiol 1996; 27(2): 311–6

    Article  PubMed  CAS  Google Scholar 

  38. Wallace WA, Wellington KL, Chess MA, et al. Comparison of nifedipine gastrointestinal therapeutic system and atenolol on antianginal efficacies and exercise hemodynamic responses in stable angina pectoris. Am J Cardiol 1994; 73(1): 23–8

    Article  PubMed  CAS  Google Scholar 

  39. Frishman WH, Klein NA, Strom JA, et al. Superiority of verapamil to propranolol in stable angina pectoris: a double-blind, randomized crossover trail. Circulation 1982; 65 (1 Pt 2): 151–9

    Google Scholar 

  40. Hauf-Zachariou U, Blackwood RA, Gunawardena KA, et al. Carvedilol versus verapamil in chronic stable angina: a multi-centre trial. Eur J Clin Pharmacol 1997; 52(2): 95–100

    Article  PubMed  CAS  Google Scholar 

  41. Deanfield JE, Detry JM, Lichtlen PR, et al. Amlodipine reduces transient myocardial ischemia in patients with coronary artery disease: double-blind Circadian Anti-Ischemia Program in Europe (CAPE Trial). J Am Coll Cardiol 1994; 24(6): 1460–7

    Article  PubMed  CAS  Google Scholar 

  42. Humen DP, Kostuk WJ. Clinical response and effects on left ventricular function of isosorbide dinitrate added to propranolol or diltiazem monotherapy in patients with chronic stable angina. Can J Cardiol 1991; 7(2): 74–80

    PubMed  CAS  Google Scholar 

  43. van Dijk RB, Lie KI, Crijns HJ. Diltiazem in comparison with metoprolol in stable angina pectoris. Eur Heart J 1988; 9(11): 1194–9

    PubMed  Google Scholar 

  44. Frishman WH, Glasser S, Stone P, et al. Comparison of controlled-onset, extended-release verapamil with amlodipine and amlodipine plus atenolol on exercise performance and ambulatory ischemia in patients with chronic stable angina pectoris. Am J Cardiol 1999; 83(4): 507–14

    Article  PubMed  CAS  Google Scholar 

  45. Santoro G, Savonitto S, Di Bello V, et al. Twenty-four-hour activity of felodipine extended release in chronic stable angina pectoris. Am J Cardiol 1991; 68(5): 457–62

    Article  PubMed  CAS  Google Scholar 

  46. Davies RF, Habibi H, Klinke WP, et al. Effect of amlodipine, atenolol and their combination on myocardial ischemia during treadmill exercise and ambulatory monitoring. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators. J Am Coll Cardiol 1995; 25(3): 619–25

    Article  PubMed  CAS  Google Scholar 

  47. Zucker DR, Griffith JL, Beshansky JR, et al. Presentations of acute myocardial infarction in men and women. J Gen Intern Med 1997; 12(2): 79–87

    Article  PubMed  CAS  Google Scholar 

  48. Just H, Frey M, Zehender M. Calcium antagonist drugs in hypertensive patients with angina pectoris. Eur Heart J 1996; 17Suppl. G: 20–4

    Article  PubMed  Google Scholar 

  49. Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation 1995; 92(5): 1326–31

    Article  PubMed  CAS  Google Scholar 

  50. Alderman MH, Cohen H, Roque R, et al. Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients. Lancet 1997; 349(9052): 594–8

    Article  PubMed  CAS  Google Scholar 

  51. Abascal VM, Larson MG, Evans JC, et al. Calcium antagonists and mortality risk in men and women with hypertension in the Framingham Heart Study. Arch Intern Med 1998; 158(17): 1882–6

    Article  PubMed  CAS  Google Scholar 

  52. Stone PH, Muller JE, Turi ZG, et al. Efficacy of nifedipine therapy in patients with refractory angina pectoris: significance of the presence of coronary vasospasm. Am Heart J 1983; 106 (4 Pt 1): 644–52

    Article  PubMed  CAS  Google Scholar 

  53. Egstrup K, Andersen Jr PE. Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol. Am J Cardiol 1993; 71(2): 177–83

    Article  PubMed  CAS  Google Scholar 

  54. Scheidt S, LeWinter MM, Hermanovich J, et al. Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial. Am J Cardiol 1986; 58(9): 715–21

    Article  PubMed  CAS  Google Scholar 

  55. Psaty BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274(8): 620–5

    Article  PubMed  CAS  Google Scholar 

  56. Pahor M, Guralnik JM, Corti MC, et al. Long-term survival and use of antihypertensive medications in older persons. J Am Geriatr Soc 1995; 43(11): 1191–7

    PubMed  CAS  Google Scholar 

  57. Jollis JG, Simpson Jr RJ, Chowdhury MK, et al. Calcium channel blockers and mortality in elderly patients with myocardial infarction. Arch Intern Med 1999; 159(19): 2341–8

    Article  PubMed  CAS  Google Scholar 

  58. Goldstein RE, Boccuzzi SJ, Cruess D, et al. Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group. Circulation 1991; 83(1): 52–60

    Article  PubMed  CAS  Google Scholar 

  59. Figulla HR, Gietzen F, Zeymer U, et al. Diltiazem improves cardiac function and exercise capacity in patients with idiopathic dilated cardiomyopathy: results of the Diltiazem in Dilated Cardiomyopathy Trial. Circulation 1996; 94(3): 346–52

    Article  PubMed  CAS  Google Scholar 

  60. Yusuf S, Peto R, Lewis J, et al. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27(5): 335–71

    Article  PubMed  CAS  Google Scholar 

  61. Effect of verapamil on mortality and major events after acute myocardial infarction (the Danish Verapamil Infarction Trial II-DAVIT II). Am J Cardiol 1990; 66(10): 779–85

    Google Scholar 

  62. Rehnqvist N, Hjemdahl P, Billing E, et al. Effects of metoprolol vs verapamil in patients with stable angina pectoris: The Angina Prognosis Study in Stockholm (APSIS). Eur Heart J 1996; 17(1): 76–81

    Article  PubMed  CAS  Google Scholar 

  63. Rengo F, Carbonin P, Pahor M, et al. A controlled trial of verapamil in patients after acute myocardial infarction: results of the calcium antagonist reinfarction Italian study (CRIS). Am J Cardiol 1996; 77(5): 365–9

    Article  PubMed  CAS  Google Scholar 

  64. Pahor M, Psaty BM, Alderman MH, et al. Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomised controlled trials. Lancet 2000; 356(9246): 1949–54

    Article  PubMed  CAS  Google Scholar 

  65. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999; 353(9169): 2001–07

    Google Scholar 

  66. Opie LH. First line drugs in chronic stable effort angina: the case for newer, longer-acting calcium channel blocking agents. J Am Coll Cardiol 2000; 36(6): 1967–71

    Article  PubMed  CAS  Google Scholar 

  67. Cohn JN, Ziesche S, Smith R, et al. Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril: V-HeFT III: Vasodilator-Heart Failure Trial (V-HeFT) Study Group. Circulation 1997; 96(3): 856–63

    Article  PubMed  CAS  Google Scholar 

  68. Heidenreich PA, McDonald KM, Hastie T, et al. Meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999; 281(20): 1927–36

    Article  PubMed  CAS  Google Scholar 

  69. Buckley MM, Grant SM, Goa KL, et al. Diltiazem: a reappraisal of its pharmacological properties and therapeutic use. Drugs 1990; 39(5): 757–806

    Article  PubMed  CAS  Google Scholar 

  70. Lakatta EG. Cardiovascular regulatory mechanisms in advanced age. Physiol Rev 1993; 73(2): 413–67

    PubMed  CAS  Google Scholar 

  71. Luomanmaki K, Inkovaara J, Hartikainen M, et al. Efficacy and tolerability of isradipine and metoprolol in treatment of hypertension: the Finnish Isradipine Study in Hypertension (FISH). J Cardiovasc Pharmacol 1992; 20(2): 296–303

    Article  PubMed  CAS  Google Scholar 

  72. Philipp T, Anlauf M, Distler A, et al. Randomised, double blind, multicentre comparison of hydrochlorothiazide, atenolol, nitrendipine, and enalapril in antihypertensive treatment: results of the HANE study. HANE Trial Research Group. BMJ 1997 Jul 19; 315(7101): 154–9

    Article  PubMed  CAS  Google Scholar 

  73. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999; 33(7): 2092–197

    Article  PubMed  CAS  Google Scholar 

  74. Brogden RN, McTavish D. Nifedipine gastrointestinal therapeutic system (GITS): a review of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in hypertension and angina pectoris. Drugs 1995; 50(3): 495–512

    Article  PubMed  CAS  Google Scholar 

  75. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 1999; 340(8): 618–26

    Article  PubMed  CAS  Google Scholar 

  76. Abrams J. Nitrate tolerance and dependence. Am Heart J 1980; 99(1): 113–23

    Article  PubMed  CAS  Google Scholar 

  77. Rajaratnam R, Brieger DB, Hawkins R, et al. Attenuation of anti-ischemic efficacy during chronic therapy with nicorandil in patients with stable angina pectoris. Am J Cardiol 1999; 83(7): 1120–4, A9

    Article  PubMed  CAS  Google Scholar 

  78. IONA Study Group. Trial to show the impact of nicorandil in angina (IONA): design, methodology, and management. Heart 2001; 85(6): E9

    Article  Google Scholar 

  79. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339(8): 489–97

    Article  PubMed  CAS  Google Scholar 

  80. Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277(2): 115–21

    Article  PubMed  CAS  Google Scholar 

  81. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999; 353(9146): 9–13

    Google Scholar 

  82. Colucci WS, Packer M, Bristow MR, et al. Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure. US Carvedilol Heart Failure Study Group. Circulation 1996; 94(11): 2800–6

    Article  PubMed  CAS  Google Scholar 

  83. Hansen JF, Hagerup L, Sigurd B, et al. Treatment with verapamil and trandolapril in patients with congestive heart failure and angina pectoris or myocardial infarction. The DAVIT Study Group. Danish Verapamil Infarction Trial. Am Heart J 1997; 134 (2 Pt 2): S48–52

    Article  PubMed  CAS  Google Scholar 

  84. Elkayam U, Shotan A, Mehra A, et al. Calcium channel blockers in heart failure. J Am Coll Cardiol 1993; 22 (4 Suppl. A): 139A–44A

    Article  PubMed  CAS  Google Scholar 

  85. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322(22): 1561–6

    Article  PubMed  CAS  Google Scholar 

  86. Terpstra WF, May JF, Smit AJ, et al. Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial. J Hypertens 2001; 19(2): 303–9

    Article  PubMed  CAS  Google Scholar 

  87. Devereux RB, Palmieri V, Sharpe N, et al. Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension: the prospective randomized enalapril study evaluating regression of ventricular enlargement (preserve) trial. Circulation 2001; 104(11): 1248–54

    Article  PubMed  CAS  Google Scholar 

  88. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension: The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997; 350(9080): 757–64

    Article  PubMed  CAS  Google Scholar 

  89. Tuomilehto J, Rastenyte D, Birkenhager WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340(9): 677–84

    Article  PubMed  CAS  Google Scholar 

  90. Hansson L, Hedner T, Lund-Johansen P, et al. Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 2000; 356(9227): 359–65

    Article  PubMed  CAS  Google Scholar 

  91. Hansson L, Lindholm LH, Ekbom T, et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999 Nov 20; 354(9192): 1751–6

    Article  PubMed  CAS  Google Scholar 

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    Sanjay Kumar &  Roger J. C. Hall

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Kumar, S., Hall, R.J.C. Drug Treatment of Stable Angina Pectoris in the Elderly. Drugs Aging 20, 805–815 (2003). https://doi.org/10.2165/00002512-200320110-00002

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