Effects of treatment with once-daily nifedipine CR and twice-daily benidipine on prevention of symptomatic attacks in patients with coronary spastic angina pectoris—Adalat Trial vs Coniel in Tokyo against Coronary Spastic Angina (ATTACK CSA)

SummaryBackgroundWe compared the efficacy of once-daily treatment with nifedipine CR 40 mg (NR) and twice-daily treatment with benidipine 4 mg (BD) in patients with coronary spastic angina (CSA) registered in 3 cardiovascular institutes in Tokyo.Methods and resultsCSA was diagnosed by an ischemic ST change during Holter ECG monitoring or drug-induced test. Thirty patients were randomly allocated to either NR or BD group. The number of symptomatic attacks and the total frequency of short-acting nitrates were examined based on the data in diaries written by patients. There were no significant differences in the baseline characteristics between the two groups. The median number (25–75% quartile) of attacks per week was significantly decreased in NR group, i.e., 1.0 (0.8–2.0) at baseline, 0.0 (0.0–1.0) after 4 weeks of treatment, and 0.0 (0.0–0.0) after 8 weeks of treatment (P = 0.0093, P = 0.0002, Wilcoxon's rank-sum test). No significant decrease was observed in BD, i.e. 1.0 (0.5–2.0) at baseline, 1.3 (0.0–3.0) after 4 weeks, and 0.0 (0.0–1.0) after 8 weeks. The number of attacks was fewer in NR than in BD group (P = 0.074, P = 0.015, U-test for difference).ConclusionOnce-daily treatment with NR 40 mg was more effective than twice-daily treatment with BD in the prevention of CSA attacks.