Efficacy and Safety of Lacidipine in Chronic Stable Angina

A Randomised, Double-blind, Placebo-controlled, Multi-centre, Parallel Group, Dose Ranging Study to Investigate the Efficacy and Safety of Lacidipine in Chronic Stable Angina.

The aim of this study was to explore whether lacidipine at doses of 2 mg, 4 mg and 6 mg decreased the symptoms of angina, compared to placebo in patients with chronic stable angina

Inclusion Criteria:

• Age 18 to 80 years
• History of stable, exertional angina pectoris (Canadian Cardiovascular Society functional class II to III) for at least 3 months duration prior to enrolment in the study
• Patients not currently receiving treatment with antianginal medication (other than short-acting nitrates)
• Between visits 2 and 3 two treadmill exercise tests, demonstrating ≥ 0.1 mV of horizontal or down sloping ST-segment depression, must be carried out. The difference in symptom-limited exercise duration between these two tests must not exceed 20%
• Total treadmill exercise duration > 3 minutes (i.e. stage 2 or above on a standard Bruce protocol)
• Coronary artery disease, preferably (not mandatory) documented by a history of proven myocardial infarction and/or coronary angiography indicating ≥ 50% reduction in luminal diameter of one or more coronary arteries or their primary branches

Exclusion Criteria:

• Myocardial infarction within 3 months prior to enrolment in the study
• Percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass surgery within 6 months
• Other types of angina (variant, unstable)
• Uncontrolled hypertension (systolic blood pressure > 180 mmHg or diastolic blood pressure > 100 mmHg)
• Resting heart rate < 50 bpm or > 100 bpm
• Significant valvular heart disease
• Heart failure New York Heart Association Class III or IV
• Chronic obstructive pulmonary disease and/or asthma with clinical symptoms requiring regular medication
• Significant arrhythmia (since this may interfere with the interpretation of the electrocardiogram) including Wolff Parkinson-White syndrome, atrial fibrillation, atrial flutter, sick sinus syndrome, significant Atrio-Ventricular heart block, intraventricular conduction defect (QRS > 0.12 seconds) ventricular pre-excitation, bundle branch block, the presence of a pace-maker, the presence of an implanted automatic defibrillator, uncorrected hypokalaemia (potassium < 3.5 mmol/litre)
• Insulin dependent diabetes mellitus
• Significant liver disease (Aspartate Aminotransferase or Alanine Aminotransferase > twice the upper limit of reference range)
• Significant renal disease (creatinine > 1.5 x upper limit of reference range)
• Any clinical condition which in the opinion of the investigator, would preclude the safe fulfilment of the protocol and the safe administration of trial medication
• Inability to perform repeated exercise testing due to extra-cardiac reasons
• Concomitant treatment with any other anti-anginal medication, whether or not prescribed for this indication (e.g. calcium channel blockers, β-blockers or long-acting nitrates)
• Concomitant treatment with anti-arrhythmic medication, digitalis or tricyclic anti-depressants or other agents known to affect ST-segment morphology
• Known hypersensitivity to any of the components of the investigational drug
• Pregnant or nursing women or women of child bearing potential
• Participation in any other clinical trial within 2 months of enrolment
• History of drug or alcohol abuse