Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina

Abstract

Aims Ivabradine, a new I_f inhibitor which acts specifically on the pacemaker activity of the sinoatrial node, is a pure heart rate lowering agent. Ivabradine has shown anti-ischaemic and anti-anginal activity in a placebo-controlled trial. The objective of this study was to compare the anti-anginal and anti-ischaemic effects of ivabradine and the beta-blocker atenolol. Methods and results In a double-blinded trial, 939 patients with stable angina were randomized to receive ivabradine 5 mg bid for 4 weeks and then either 7.5 or 10 mg bid for 12 weeks or atenolol 50 mg od for 4 weeks and then 100 mg od for 12 weeks. Patients underwent treadmill exercise tests at randomization (M₀) and after 4 (M₁) and 16 (M₄) weeks of therapy. Increases in total exercise duration (TED) at trough at M₄ were 86.8±129.0 and 91.7±118.8 s with ivabradine 7.5 and 10 mg, respectively and 78.8±133.4 s with atenolol 100 mg. Mean differences (SE) when compared with atenolol 100 mg were 10.3 (9.4) and 15.7 (9.5) s in favour of ivabradine 7.5 and 10 mg (PM₁ improved by 64.2±104.0 s with ivabradine 5 mg and by 60.0±114.4 s with atenolol 50 mg (PConclusion Ivabradine is as effective as atenolol in patients with stable angina.