Comparison of the antiischaemic and antianginal effects of nicorandil and amlodipine in patients with symptomatic stable angina pectoris: the SWAN study

Journal of Clinical and Basic Cardiology 1999; 2 (2): 213-217

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Keywords: Amlodipin,  Belastungstest,  Kaliumkanalöffner,  Kalziumkanalblocker,  Koronare Herzkrankheit,  Nicorandil,  amlodipine,  calcium channel blocker,  coronary heart disease,  exercise tolerance test,  Nicorandil,  potassium channel activator

This multicentre, double-blind, randomised study compared the antiischaemic and antianginal effects of nicorandil and amlodipine in patients with symptomatic stable angina pectoris. Nicorandil is a new coronary and balanced peripheral vasodilating agent that operates through two mechanisms of action: activation of ATP-dependent K-channels and stimulation of guanylate cyclase. A total of 121 patients with symptomatic stable angina pectoris were randomised to receive nicorandil 10 mg twice daily (bd) or amlodipine 5 mg once daily (od) for 8 weeks (optional dosage increase after 2-4 weeks to 20 mg bd and 10 mg od, respectively). Symptom-limited exercise tolerance tests were performed at baseline, and after 2 and 8 weeks treatment, respectively. In addition, the number of anginal attacks, nitroglycerin (NTG) usage, blood pressure (BP), heart rate (HR) and adverse events were recorded, and a subjective assessment of quality of life performed. 118 patients (nicorandil, n=56; amlodipine, n=62) were evaluable for efficacy. Time to onset of ST-segment depression increased only in the amlodipine-group whereas time to anginal pain along with total exercise duration increased in both treatment groups. Both nicorandil and amlodipine reduced the magnitude of ST-segment depression at maximal identical workload, while the sum of weekly anginal attacks and the number of NTG units required for pain relief decreased. No differences were apparent between treatment groups for any of these target variables. HR remained unchanged in both groups. Resting BP decreased in the amlodipine group, but not among nicorandil recipients. In both treatment groups, ratings for quality of life variables improved over the course of the study. Compared with amlodipine, nicorandil was associated with a more favourable tolerability profile. The antiischaemic and antianginal effects of nicorandil were comparable to amlodipine in patients with symptomatic stable angina pectoris. In addition, both drugs were generally well tolerated and had a positive effect on quality of life in this patient population. J Clin Basic Cardiol 1999; 2: 213-7.