The combination of nifedipine and propranolol in the management of patients with angina pectoris.

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Abstract
1 A double-blind cross over study was carried out to assess the effects of the combination of nifedipine and propranolol in 25 patients with chronic stable angina pectoris at beta-adrenoceptor blockade. 2 Efficacy was judged objectively by a standardized exercise protocol using a bicycle ergometer and subjectively by patient assessment of anginal attack rate. 3 The combination of nifedipine and propranolol was shown to be effective with an increase in exercise time to angina and an increase in physical work capacity expressed in terms of calculated maximal oxygen uptake (VO2 max). There was an associated reduction in anginal attack rate. 4 The synergistic effect was even more pronounced after reduction in propranolol dosage to 50% of the beta-adrenoceptor blocking dose, reflecting the myocardial depressant effects of beta-adrenoceptor blocking drugs in these patients with coronary heart disease, some of whom had poor left ventricular function.