Preventive chronotherapy of diltiazem in old patients with ischemic heart disease, stable stenocardia II–III functional classes

BACKGROUND: This study developed a new variant of chronotherapy — preventive chronotherapy with a calcium antagonist of prolonged action — diltiazem, which is provided before the onset of myocardial ischemia (painful and pain-free) in accordance with ECG monitoring data in older patients with stable angina pectoris.

AIM: This study aimed to examine the effectiveness of preventive chronotherapy with diltiazem in older patients with coronary heart disease and stable angina pectoris of II–III functional classes in comparison with traditional treatment with diltiazem without taking into account the onset of myocardial ischemia during the day.

MAATERIALS AND METHODS: The study included two randomized groups of patients with coronary heart disease, i.e., stable angina pectoris. Group 1 included patients (n=15) receiving preventive chronotherapy with diltiazem. Group 2 consisted of patients (n=10) with angina pectoris of 2–3 functional classes treated with diltiazem by the traditional method. EchoСG was used in the work. ECG–Holter monitoring and bimanual physical activity were conducted. The course of treatment was 10 days.

RESULTS: The results indicated the advantage of preventive chronotherapy with diltiazem in comparison with traditional treatment. This is confirmed by a more pronounced therapeutic effect in the form of an improvement in myocardial contractile function, decrease in myocardial energy expenditure, increase in exercise tolerance and antianginal, anti-ischemic, and vasodilating effects of diltiazem used in preventive chronotherapy mode (i.e., with an increase in the occurrence time of myocardial ischemia).

CONCLUSION: The study data obtained made it possible to establish more pronounced antianginal, anti-ischemic, and hypotensive effects of preventive chronotherapy with diltiazem than these effects of traditional treatment. Moreover, preventive chronotherapy was associated with a greater tolerance to physical activity and a decrease in myocardial energy expenditure.