Effects of angiotensin-converting enzyme inhibition on transient ischemia
The quinapril anti-ischemia and symptoms of angina reduction (QUASAR) trial
Carl J. Pepine, MD, MACC*,*,
Jean-Lucien Rouleau, MD, FACC ,
Karen Annis, MPH ,
Anique Ducharme, MD ,
Patrick Ma, MD, FACC||,
Jacques Lenis, MD, FACC¶,
Richard Davies, MD, FACC#,
Udho Thadani, MD, FACC**,
Bernard Chaitman, MD, FACC,
Harry E. Haber, MPH,
S. Ben Freedman, MB, PhD, FACC,
Milton L. Pressler, MD, FACC,
Bertram Pitt, MD, FACC QUASAR Study Group
* University of Florida College of Medicine, Division of Cardiovascular Medicine, Gainesville, Florida, USA
University Health Network, Division of Cardiology, Toronto, Ontario, Canada
Pfizer, Inc., Ann Arbor, Michigan, USA
Montreal Heart Institute, Montreal, Quebec, Canada
|| Heart Health Institute, Research Center, Calgary, Alberta, Canada
¶ Invascor Clinical Research, Quebec, Canada, Centre Hospitalier Pierre Boucher, Longueuil, Quebec Canada
# Ottawa Civic Hospital, Ottawa, Ontario, Canada
** University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Cardiology Section, Oklahoma City, Oklahoma, USA
St. Louis University ECG Core Laboratory, St. Louis, Missouri, USA
Concord Repatriation General Hospital, Department of Cardiology, University of Sydney, Sydney, Australia
University of Michigan Medical Center, Department of Medicine, Ann Arbor, Michigan, USA
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Figure 1 Schematic of the QUASAR study design. Q = quinapril; R = randomize. After a 2- to 4-week single-blind placebo period (Period 1) patients were randomly assigned to two groups. Group 1 received double-blind placebo for 8 weeks (Period 2) and then double-blind Q 80 mg/day for 8 weeks (Period 3). In the latter, there was a 1 week dose titration from 40 to 80 mg/day. Group 2 received double-blind Q 40 mg/day for 8 weeks (Period 2) followed by double-blind Q 40 mg/day for an additional 8 weeks (Period 3).
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Figure 2 Time (min) to induce 1-mm ST-segment depression during exercise treadmill test at 8 weeks of therapy—evaluable population. The percentage of patients with ischemic-type ST-segment depression appears on the vertical axis, and time (min) is on the horizontal axis. There was no difference between treatment group 1 (placebo) and group 2 (40 mg/day quinapril) at 8 weeks.
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Figure 3 Time (min) to induce level 2 angina during exercise treadmill test at 8 weeks of therapy—evaluable population. The percentage of patients with level 2 angina appears on the vertical axis, and time (min) is on the horizontal axis. There was no difference between treatment group 1 (placebo) and group 2 (40 mg/day quinapril) at 8 weeks.
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Figure 4 Summary of the three exercise (Ex) parameters for treatment groups 1 and 2. All exercise times increased over the study period (baseline to 8 weeks and 8 to 16 weeks). The increases were not associated with whether patients had received active drug, nor were they dose-dependent; thus, they are likely to be training-related. ST SD = ST-segment depression.
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Figure 5 Heart rate (beats/min) at peak exercise at baseline and at 8 and 16 weeks of therapy. There was no significant difference between treatment group 1 (open bars) and group 2 (solid bars).
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Figure 6 Systolic blood pressure (mm Hg) at peak exercise at baseline and at 8 and 16 weeks of therapy. There was no significant difference between treatment group 1 (open bars) and group 2 (solid bars).
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