29591
document
Role of diltiazem in the treatment of silent myocardial ischemia . Silent myocardial ischemia is a frequent finding when Holter monitoring is done in patients with advanced coronary disease . Silent ischemia is associated with a worse prognosis in patients with stable or unstable angina , survivors of myocardial infarction , and populations at risk for coronary disease . Whether medical therapy for silent ischemia improves prognosis is not known . In a randomized , placebo-controlled , multicenter trial of 60 patients with documented coronary disease , positive exercise tests , and ischemic episodes on Holter monitoring , long-acting diltiazem reduced ischemic episodes by 50 % compared to placebo , from a mean of 5.6 to 2.8 ( p less than 0.0001 ) . Efficacy was maintained over 24 h and diltiazem also significantly improved exercise test parameters . Three smaller studies also demonstrated that diltiazem effectively reduces ambulatory ischemia ; however , results with nifedipine are conflicting , with several studies showing no benefit . In contrast , beta-blockers reliably reduce ischemic episodes . The role of medical therapy for silent ischemia will be clarified only when its effect upon morbidity and mortality are determined .
29592
Intervention_Pharmacological
diltiazem
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Intervention_Control
placebo-controlled
29594
Intervention_Pharmacological
diltiazem
29595
Intervention_Control
placebo
29596
Intervention_Pharmacological
diltiazem
29597
Intervention_Pharmacological
diltiazem
29598
Outcome_Physical
ischemic episodes
29599
Outcome_Other
Efficacy
29600
Outcome_Other
exercise test parameters
29601
Outcome_Physical
ambulatory ischemia
29602
Outcome_Physical
ischemic episodes
29603
Participant_Condition
advanced coronary disease
29604
Participant_Sample-size
60
29605
Participant_Condition
coronary disease ,