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October 6, 1969, Vol 210, No. 1 >
ARTICLE | October 6, 1969

Evaluation of Long-Term Use of Propranolol in Angina Pectoris FREE

Ezra A. Amsterdam, MD; Richard Gorlin, MD; Steven Wolfson, MD
[+] Author Affiliations

Reprint requests to 721 Huntington Ave, Boston 02115 (Dr. Gorlin).


JAMA. 1969;210(1):103-106. doi:10.1001/jama.1969.03160270065012
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References

The effect of propranolol hydrochloride therapy for angina pectoris was evaluated by double-blind trial in 121 patients with the anginal syndrome. Ninety-five patients had coronary artery disease, and 26 had normal coronary arteries. Successful therapy was achieved in 83 patients (86%) with coronary artery disease, whereas only six (23%) with normal coronary arteries responded favorably. Not distinguishing features could be found between those patients with coronary artery disease successfully treated with propranolol and those who failed to respond. Side effects occurred in 31% of the patients but necessitated withdrawal of treatment in only two instances. These results indicate that propranolol is highly effective in the prolonged treatment of angina pectoris when this is caused by coronary atherosclerosis and the dose of drug is individualized for each patient.

REFERENCES

1 +
Wolfson, S., et al:  Propranolol and Angina Pectoris , AmerJ Cardiol 18:345-352, 1966;.
2 +
Grant, R.H.E., et al:  Multicentre Trial of Propranolol in Angina Pectoris , Amer J Cardiol 18:361-365, 1966;.
3 +
Gillam, P.M.S., and Prichard, B.N.C.:  Propranolol in the Therapy of Angina Pectoris , Amer J Cardiol 18:366-369, 1966;.
4 +
Rabkin, R., et al:  The Prophylactic Value of Propranolol in Angina Pectoris , Amer J Cardiol 18:370-380, 1966;.
5 +
Ginn, W.M., and Orgain, E.S.:  Propranolol Hydrochloride in the Treatment of Angina Pectoris , JAMA 198:1214-1216 ( (Dec 12) ) 1966;.
6 +
Nestel, P.J.:  Evaluation of Propranolol (Inderal) in the Treatment of Angina Pectoris , Med J Aust 2:1274-1276, 1966;.
7 +
Gianelly, R.E., et al:  Propranolol in Patients With Angina Pectoris , Ann Intern Med 67:1216-1225, 1967;.
8 +
Keelan, P.:  Double-Blind Trial of Propranolol (Inderal) in Angina Pectoris , Brit Med J 1:897-898, 1965;.
9 +
Hebb, A.R.; Godwin, T.F.; and Gunton, R.W.:  New Beta Adrenergic Blocking Agent, Propranolol, in Treatment of Angina Pectoris , Canad Med Assoc J 98:246-251, 1968;.
10 +
Hamer, J., and Sowton, E.:  Effects of Propranolol on Exercise Tolerance in Angina Pectoris , Amer J Cardiol 18:354-358, 1966;.
11 +
Ahlquist, R.P.:  Study of Adrenotropic Receptors , Amer J Physiol 153:586-600, 1948;.
12 +
Eckstein, R.W., et al:  Effects of Control of Cardiac Work Upon Coronary Flow and O2 Consumption After Sympathetic Nerve Stimulation , Amer J Physiol 163:539-544, 1950;.
13 +
Gerola, A.; Feinberg, H.; and Katz, L.N.:  Role of Catecholamines on Energetics of the Heart and Its Blood Supply , Amer J Physiol 196:394-400, 1959;.
14 +
Yurchak, P.M., et al:  Effects of Norepinephrine on the Coronary Circulation in Man , Circulation 30:180-187, 1964;.
15 +
Sullivan, J.M., and Gorlin, R.:  Effect of 1-Epinephrine on the Coronary Circulation in Human Subjects With and Without Coronary Artery Disease , Circ Res 21:919-923, 1967;.
16 +
Bucher, H.K.:  Appraisal of Drugs Intended to Alter Subjective Responses, Symptoms , JAMA 158:399-401 ( (June 4) ) 1955;.
17 +
Likoff, W.; Segal, B.L.; and Kasparian, H.:  Normal Selective Coronary Arteriograms in Coronary Heart Disease , New Eng J Med 276:1063-1066, 1967;.
18 +
Proudfit, W.L.; Shirey, E.K.; and Sones, Jr., F.M.:  Selective Cine Coronary Arteriography: Correlation With Clinical Findings in 1,000 Patients , Circulation 33:901-910, 1966;.
19 +
Kemp, H.G.; Elliot, W.C.; and Gorlin, R.:  The Anginal Syndrome With Normal Coronary Arteriography , Trans Assoc Amer Physicians 80:59-68, 1967;.
20 +
Amsterdam, E.A.; Wolfson, S.; and Gorlin, R.:  Evaluation of Long-Term Use of Propranolol in Angina Pectoris , Amer J Cardiol 23:104, 1969;.
21 +
Gorlin, R.:  Pathophysiology of Cardiac Pain , Circulation 32:138-148, 1965;.
22 +
Epstein, S.E., et al:  Effects of Beta-Adrenergic Blockade on the Cardiac Response to Maximal and Submaximal Exercise in Man , J Clin Invest 14:1745-1753, 1965;.
23 +
Sonnenblick, E.H., et al:  Effects of Exercise on Myocardial Force-Velocity Relations in Intact Unanesthetized Man: Relative Roles of Changes in Heart Rate, Sympathetic Activity and Ventricular Dimensions , J Clin Invest 44:2051-2062, 1965;.
24 +
Robinson, B.F., et al:  Control of Heart Rate by the Autonomic Nervous System: Studies in Man on the Interrelation Between Baroreceptor Mechanisms and Exercise , Circ Res 19:400-411, 1966;.
25 +
Bogdonoff, M.D., et al:  Metabolic and Cardiovascular Changes During a State of Acute Central Nervous System Arousal , J Clin Endocr 20:1333-1340, 1960;.
26 +
Friedman, M., et al:  Excretion of Catecholamines, 17-Ketosteroids, 17-Hydroxycorticoids and 5-Hydroxyindole in Men Exhibiting a Particular Behavior Pattern (A) Associated With High Incidence of Clinical Coronary Artery Disease , J Clin Invest 39:758-764, 1960;.
27 +
Nestel, P.J., and Hammond, J.:  Relationship Between S-T Segment Depression During Exercise and Increments in the Urinary Excretion of 3-Methoxy 4-Hydroxy Mandelic Acid in Men With Coronary Heart Disease , Aust Ann Med 16:151-154, 1967;.
28 +
Nestel, P.J.; Verghese, A.; and Lovell, R.R.H.:  Catecholamine Secretion and Sympathetic Nervous Responses to Emotion in Men With and Without Angina Pectoris , Amer Heart J 73: 227-234, 1967;.
29 +
Robin, E., et al:  A Comparative Study of Nitroglycerin and Propranolol , Circulation 36:175-186, 1967;.
30 +
Wolfson, S., and Gorlin, R.:  Cardiovascular Pharmacology of Propranolol in Man , Circulation , to be published.
31 +
Sowton, E., and Hamer, J.:  Hemodynamic Changes After Beta Adrenergic Blockade , Amer J Cardiol 18:317-320, 1966;.
32 +
Bloomfield, D.A., and Sowton, E.:  Rate-Independent Effects of Propranolol: The Differentiation Between Chronotropic, Inotropic, and Peripheral Vascular Responses , Circ Res 21:243-247, 1967;.
33 +
Robinson, B.F.:  Relation of Heart Rate and Systolic Blood Pressure to the Onset of Pain in Angina Pectoris , Circulation 35: 1073-1083, 1967;.
34 +
Naylor, W.G., et al:  Effect of Propranolol, a Beta-Adrenergic Antagonist, on Blood Flow in the Coronary and Other Vascular Fields , Amer Heart J 73:207-216, 1967;.
35 +
Srivastava, A.C.; Dewar, H.A.; and Newell, D.J.:  Double-Blind Trial of Propranolol (Inderal) in Angina of Effort , Brit Med J 2:724-725, 1964;.
36 +
Aronow, W.S., and Kaplan, M.A.:  Propranolol With Isosorbide Dinitrate Versus Placebo in Angina Pectoris , New Eng J Med 280:847-850, 1969;.
37 +
Stephen, S.A.:  Unwanted Effects of Propranolol , Amer J Cardiol 18:463-468, 1966;.
38 +
Conway, N.; Seymour, J.; and Gelson, A.:  Cardiac Failure in Patients With Valvular Heart Disease After Use of Propranolol to Control Atrial Fibrillation , Brit Med J 1:213-214, 1968;.

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1 +
Wolfson, S., et al:  Propranolol and Angina Pectoris , AmerJ Cardiol 18:345-352, 1966;.
2 +
Grant, R.H.E., et al:  Multicentre Trial of Propranolol in Angina Pectoris , Amer J Cardiol 18:361-365, 1966;.
3 +
Gillam, P.M.S., and Prichard, B.N.C.:  Propranolol in the Therapy of Angina Pectoris , Amer J Cardiol 18:366-369, 1966;.
4 +
Rabkin, R., et al:  The Prophylactic Value of Propranolol in Angina Pectoris , Amer J Cardiol 18:370-380, 1966;.
5 +
Ginn, W.M., and Orgain, E.S.:  Propranolol Hydrochloride in the Treatment of Angina Pectoris , JAMA 198:1214-1216 ( (Dec 12) ) 1966;.
6 +
Nestel, P.J.:  Evaluation of Propranolol (Inderal) in the Treatment of Angina Pectoris , Med J Aust 2:1274-1276, 1966;.
7 +
Gianelly, R.E., et al:  Propranolol in Patients With Angina Pectoris , Ann Intern Med 67:1216-1225, 1967;.
8 +
Keelan, P.:  Double-Blind Trial of Propranolol (Inderal) in Angina Pectoris , Brit Med J 1:897-898, 1965;.
9 +
Hebb, A.R.; Godwin, T.F.; and Gunton, R.W.:  New Beta Adrenergic Blocking Agent, Propranolol, in Treatment of Angina Pectoris , Canad Med Assoc J 98:246-251, 1968;.
10 +
Hamer, J., and Sowton, E.:  Effects of Propranolol on Exercise Tolerance in Angina Pectoris , Amer J Cardiol 18:354-358, 1966;.
11 +
Ahlquist, R.P.:  Study of Adrenotropic Receptors , Amer J Physiol 153:586-600, 1948;.
12 +
Eckstein, R.W., et al:  Effects of Control of Cardiac Work Upon Coronary Flow and O2 Consumption After Sympathetic Nerve Stimulation , Amer J Physiol 163:539-544, 1950;.
13 +
Gerola, A.; Feinberg, H.; and Katz, L.N.:  Role of Catecholamines on Energetics of the Heart and Its Blood Supply , Amer J Physiol 196:394-400, 1959;.
14 +
Yurchak, P.M., et al:  Effects of Norepinephrine on the Coronary Circulation in Man , Circulation 30:180-187, 1964;.
15 +
Sullivan, J.M., and Gorlin, R.:  Effect of 1-Epinephrine on the Coronary Circulation in Human Subjects With and Without Coronary Artery Disease , Circ Res 21:919-923, 1967;.
16 +
Bucher, H.K.:  Appraisal of Drugs Intended to Alter Subjective Responses, Symptoms , JAMA 158:399-401 ( (June 4) ) 1955;.
17 +
Likoff, W.; Segal, B.L.; and Kasparian, H.:  Normal Selective Coronary Arteriograms in Coronary Heart Disease , New Eng J Med 276:1063-1066, 1967;.
18 +
Proudfit, W.L.; Shirey, E.K.; and Sones, Jr., F.M.:  Selective Cine Coronary Arteriography: Correlation With Clinical Findings in 1,000 Patients , Circulation 33:901-910, 1966;.
19 +
Kemp, H.G.; Elliot, W.C.; and Gorlin, R.:  The Anginal Syndrome With Normal Coronary Arteriography , Trans Assoc Amer Physicians 80:59-68, 1967;.
20 +
Amsterdam, E.A.; Wolfson, S.; and Gorlin, R.:  Evaluation of Long-Term Use of Propranolol in Angina Pectoris , Amer J Cardiol 23:104, 1969;.
21 +
Gorlin, R.:  Pathophysiology of Cardiac Pain , Circulation 32:138-148, 1965;.
22 +
Epstein, S.E., et al:  Effects of Beta-Adrenergic Blockade on the Cardiac Response to Maximal and Submaximal Exercise in Man , J Clin Invest 14:1745-1753, 1965;.
23 +
Sonnenblick, E.H., et al:  Effects of Exercise on Myocardial Force-Velocity Relations in Intact Unanesthetized Man: Relative Roles of Changes in Heart Rate, Sympathetic Activity and Ventricular Dimensions , J Clin Invest 44:2051-2062, 1965;.
24 +
Robinson, B.F., et al:  Control of Heart Rate by the Autonomic Nervous System: Studies in Man on the Interrelation Between Baroreceptor Mechanisms and Exercise , Circ Res 19:400-411, 1966;.
25 +
Bogdonoff, M.D., et al:  Metabolic and Cardiovascular Changes During a State of Acute Central Nervous System Arousal , J Clin Endocr 20:1333-1340, 1960;.
26 +
Friedman, M., et al:  Excretion of Catecholamines, 17-Ketosteroids, 17-Hydroxycorticoids and 5-Hydroxyindole in Men Exhibiting a Particular Behavior Pattern (A) Associated With High Incidence of Clinical Coronary Artery Disease , J Clin Invest 39:758-764, 1960;.
27 +
Nestel, P.J., and Hammond, J.:  Relationship Between S-T Segment Depression During Exercise and Increments in the Urinary Excretion of 3-Methoxy 4-Hydroxy Mandelic Acid in Men With Coronary Heart Disease , Aust Ann Med 16:151-154, 1967;.
28 +
Nestel, P.J.; Verghese, A.; and Lovell, R.R.H.:  Catecholamine Secretion and Sympathetic Nervous Responses to Emotion in Men With and Without Angina Pectoris , Amer Heart J 73: 227-234, 1967;.
29 +
Robin, E., et al:  A Comparative Study of Nitroglycerin and Propranolol , Circulation 36:175-186, 1967;.
30 +
Wolfson, S., and Gorlin, R.:  Cardiovascular Pharmacology of Propranolol in Man , Circulation , to be published.
31 +
Sowton, E., and Hamer, J.:  Hemodynamic Changes After Beta Adrenergic Blockade , Amer J Cardiol 18:317-320, 1966;.
32 +
Bloomfield, D.A., and Sowton, E.:  Rate-Independent Effects of Propranolol: The Differentiation Between Chronotropic, Inotropic, and Peripheral Vascular Responses , Circ Res 21:243-247, 1967;.
33 +
Robinson, B.F.:  Relation of Heart Rate and Systolic Blood Pressure to the Onset of Pain in Angina Pectoris , Circulation 35: 1073-1083, 1967;.
34 +
Naylor, W.G., et al:  Effect of Propranolol, a Beta-Adrenergic Antagonist, on Blood Flow in the Coronary and Other Vascular Fields , Amer Heart J 73:207-216, 1967;.
35 +
Srivastava, A.C.; Dewar, H.A.; and Newell, D.J.:  Double-Blind Trial of Propranolol (Inderal) in Angina of Effort , Brit Med J 2:724-725, 1964;.
36 +
Aronow, W.S., and Kaplan, M.A.:  Propranolol With Isosorbide Dinitrate Versus Placebo in Angina Pectoris , New Eng J Med 280:847-850, 1969;.
37 +
Stephen, S.A.:  Unwanted Effects of Propranolol , Amer J Cardiol 18:463-468, 1966;.
38 +
Conway, N.; Seymour, J.; and Gelson, A.:  Cardiac Failure in Patients With Valvular Heart Disease After Use of Propranolol to Control Atrial Fibrillation , Brit Med J 1:213-214, 1968;.

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