Treatment of Obese Non-Diabetic Patients with Phenformin. A Double-Blind Cross-Over Trial

The effect of 50 mg. of sustained release phenformin capsules administered twice daily was compared with a placebo as an aid to weight reduction in obese non-diabetic patients. Phenformin and placebo were administered alternately in two three-month periods.Weight loss on a 1,200-calorie diet was greater in the first three months than in the second three months regardless of treatment. There was no difference in weight loss between the phenformin and placebo groups in either the first or second three-month period. Serum cholesterol levels tended to fall in association with weight loss, but not apparently in relation to the size of the weight loss or to the treatment.     

Practolol in Treatment of Angina Pectoris. A Double-blind Trial

Twenty-four patients with angina pectoris entered a double-blind trial of the cardioselective beta-adrenergic blocking agent practolol. Seventeen experienced less angina and consumed fewer glyceryl trinitrate tablets when on the active preparation. There was also a decrease in the mean number of attacks suffered by patients while on practolol and a reduction in the number of glyceryl trinitrate tablets taken. These results are of statistical significance at, at least, the 5% level.     

Comparison of Adrenergic Beta-receptor Antagonists in Angina Pectoris

The symptomatic, electrocardiographic, and circulatory effects of intravenous and oral preparations of propranolol, oxprenolol, and practolol were compared in 16 patients with uncomplicated angina pectoris precipitated by exertion. The method of study included treadmill exercise, double-blind assessment, single-blind analysis, with placebo control and randomized serial comparison of each drug in each patient. The doses used were selected to give the same near-maximum suppression of the heart rate response to exercise. The symptomatic, electrocardiographic, and circulatory response of each patient to both preparations of each of the three drugs was similar. Exercise tolerance was increased in two-thirds, unchanged in one-sixth, and significantly worsened in one-sixth of the studies. Electrocardiographic evidence of myocardial ischaemia was conspicuously reduced by all three drugs in most studies irrespective of their symptomatic effects. Though the exclusive choice of patients, the single dose design of the trial, and the treadmill method of assessment limit the general application of these results, they do clearly indicate that in doses that induce equal suppression of the exercise heart rate these three drugs have similar distinct anti-anginal activity. Their ancillary pharmacological properties are probably of little importance in this respect. Equally, the similarity in the symptomatic, circulatory, and electrocardiographic response to the intravenous and oral preparations suggests that metabolic breakdown products are probably of therapeutic importance only in so far as they antagonize beta-receptor activity.     

Comparison of Adrenergic Beta-blocking Drugs in Angina Pectoris

The symptomatic, electrocardiographic, and haemodynamic effects of two adrenergic beta-blocking drugs, oxprenolol and propranolol, have been compared in equipotent intravenous doses in six patients with uncomplicated angina pectoris during treadmill exercise. The method of comparison included double-blind assessment and analysis with placebo control and randomized serial comparison in each patient. Both drugs produced an equal amelioration in symptoms in most of the patients. This was closely correlated with improvement in the electrocardiographic changes and a significant reduction in the exercising heart rate and systemic arterial pressure. This method of double-blind combined subjective and objective assessment carries distinct advantages in the comparative assessment of drug treatments in angina pectoris.     

New Trends in the Treatment of Angina Pectoris

Traditionally when considering the pharmacologic basis of therapy in angina pectoris, attention is focussed on alterations of coronary blood flow. Yet the diseased coronary arteries in these patients often do not appear to be capable of responding to vasodilatory drugs. Since the pain of myocardial ischemia is relieved by a number of interventions without an increase in coronary blood flow, the concept herein considered is that angina pector is best viewed as an unfavorable relation between myocardial oxygen requirements and availability. Thus, the clinical value of the major antianginal agents is thought to be based importantly upon their actions to reduce myocardial oxygen consumption rather than to increase coronary blood flow.Sublingual nitroglycerin possesses a powerful dilator effect on veins which reduces venous return and thereby the size of the heart and intra-myocardial tension; thus myocardial oxygen requirements are diminished.The beta-adrenergic receptor blocking drug, propranolol (Inderal®), inhibits sympathetic stimulation of the heart at rest and during exercise. Thus, myocardial oxygen requirements are diminished by the reduction in heart rate and diminished contractility. As a result of this latter action, cardiac output is reduced and thereby arterial pressure and intramyocardial tension is lowered. In patients with advanced heart disease and borderline cardiac compensation, propranolol is hazardous because it removes the availability of one of the important reserve mechanisms for maintaining cardiac compensation—the sympathetic support of the failing heart.The introduction of electrical stimulation of the carotid sinus nerves as a means of therapy in patients with angina pectoris has provided a powerful tool for the treatment of patients with refractory ischemic pain.     

120 例不稳定型心绞痛的地尔硫卓治疗临床观察

目的:探讨地尔硫卓治疗不稳定型心绞痛的临床疗效,以供医生参考使用。方法:将我院2010年1月~2011年5月收治的120例不稳定型心绞痛的患者随机分为两组,对照组患者给予硝酸甘油,实验组患者给予地尔硫卓,比较两组患者的治疗效果。结果:实验组患者的总有效率为93.33%(56/60),对照组患者总有效率为78.33%(47/60),实验组明显优于对照组患者,P<0.05。结论:地尔硫卓治疗不稳定型心绞痛具有较好的疗效,值得在临床应用。     

应用降纤酶治疗不稳定型心绞痛的临床疗效观察

目的探讨降纤酶(Dfd)治疗不稳定型心绞痛(UAP)的疗效。方法将62例UAP患者随机分组A组(32例)给予口服阿斯匹林(300mg·d-1)和抗心绞痛药,B组(30例)在A组治疗基础上,另加Dfd(10U·d-1共3d)静脉点滴。结果A组和B组在住院10d内每天心绞痛发作次数、非致死性心肌梗死、心性死亡、24h缺血总负荷、ΣST及纤维蛋白原分别为5.5±2.3与3.2±0.5(P<0.01)、9%与0(P<0.01)、6%与0(P<0.01),1868±846与735±282(P<0.5)、3.4±0.7与1.4±0.6(P<0.01)、3.9±0.6与1.0±0.4(P<0.01),B组无一例发生出血倾向。结论UAP患者急性期用Dfb治疗有效、安全便利。