A Practitioner Based Evaluation of Nicorandil on Symptoms and Quality of Life in Patients with Chronic Stable Angina Pectoris

Journal of Clinical and Basic Cardiology 2001; 4 (2): 149-152

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Keywords: Angina pectoris,  Lebensqualität,  Nicorandil,  Angina pectoris,  Nicorandil,  quality of life

Nicorandil is an antianginal agent with unique pharmacological properties combining a nitrate-like action with vasodilation through opening of ATP-potassium channels. The antianginal effects of nicorandil have been carefully studied in mostly small, comparative trials but its usefulness outside of the setting of clinical trials is less well studied. We investigated the antianginal effects (patient diary for angina episodes and nitroglycerin consumption for immediate pain relief) of nicorandil in 200 patients (46 % females, 71.4 ± 9.9 years) followed by 56 primary care physicians in general practice. Nicorandil was started at 2 x 10 mg and, increased after 3 weeks to 2 x 20 mg, if tolerated and judged necessary, for a total of 12 weeks. Nicorandil was given as monotherapy in 22 % and in combination with beta-blockers, calcium antagonists or long-acting nitrates in 78 % of patients. An assessment of quality of life was performed at baseline and at week 12. Nicorandil was withdrawn in 14 patients (7 %) because of headache and/or flushing and in 10 patients because of acute illnesses unrelated to therapy or administrative reasons. After 12 weeks, nicorandil resulted in small but statistically significant (p < 0.05) decreases of systolic (?5.0 ± 14.3 mmHg) and diastolic (?2.4 ± 8.6 mmHg) blood pressure and heart rate (?1.9 ± 9.0 bts/min). Weekly anginal episodes and nitroglycerin consumption decreased markedly by -5 ± 6.3 and ?5.6 ± 8.5 (p < 0.001) and ratings of quality of life improved for all aspects (p < 0.001). Both patients and physicians rated efficacy and tolerability in 80 to 90 % as excellent or good and 169 out of 174 patients opted for long-term nicorandil therapy after 12 weeks. Thus, nicorandil given alone or in combination proved to be highly efficacious and well tolerated in patients with chronic stable angina pectoris followed by their private physicians in general practice.