GUSTO: is science or money talking?
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Biomedical subjects
Publications and source records attributed to G Jackson.
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The safety and tolerability of intermittent (16 hours on/8 hours off) nitrate patch therapy (0.2, 0.4 or 0.6 mg/hr: dose adjusted as required) was studied for a median duration of 356 days in 106 patients (mean age 60.9 +/- 8.6 years) with angina pectoris. Most patients (82%) were on existing beta-blocker and/or calcium antagonist therapy. Safety, tolerability and efficacy data were obtained by means of patient diary cards and regular clinic visits. Almost 90 treatment years revealed no significant or serious adverse events, and there were no changes in haematology or biochemistry associated with intermittent nitrate patch therapy. The most frequently reported side-effects were headache, skin reactions and dizziness (53%, 20% and 8% of patients respectively). Treatment resulted in a sustained reduction in the frequency and severity of angina attacks, reduced sublingual GTN consumption, an improvement in general wellbeing and a rise in the proportion of patients in whom angina was controlled.
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Sixty-three patients with mild to moderate hypertension completed a double-blind, randomised crossover trial of atenolol 100 mg daily, enalapril 20 mg daily and the fixed combination atenolol 50 mg and nifedipine retard 20 mg (Tenif) once daily. In the three areas of efficacy that the study compared-24-hour post dose blood pressure, control of blood pressure over the dosing period with particular reference to the waking day and attenuation of systolic blood pressure on exercise-atenolol and the fixed combination demonstrated greater efficacy than enalapril.
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This study was designed to evaluate whether hormone replacement therapy with tibolone demonstrated similar effects to those observed with oestrogen on myocardial ischaemia and angina. Ten postmenopausal women with documented coronary artery disease were evaluated by treadmill exercise electrocardiograms before and 24 hours after the oral administration of tibolone 2.5 mg. Onset of myocardial ischemia, as defined by ST segment depression, increased by a median 102 seconds (p = 0.022). Time to onset of angina increased by 31 seconds (p = 0.038), while total exercise time was not significantly affected (p = 0.24). Haemodynamic variables in the form of heart rate, systolic blood pressure and their product were unaffected by tibolone administration. We conclude that tibolone appears to show similar anti-ischaemic properties to oestrogen.