Антиангинальная эффективность и переносимость ивабрадина в терапии пациентов со стабильной стенокардией: результаты исследования КОНТРОЛЬ
Control of heart rate (HR) is an important target during treatment of patients with stable angina. In a number of cases it can be achieved by the use of β adrenoblockers. But often a necessity arises to enhance pulse slowing therapy with the use of combinations of drugs exerting negative chronotropic effect. We present here results of the CONTROL study (n=1777), conducted with the aim of studying antianginal efficacy and tolerability of the If channels blocker ivabradine used in combination with β adrenoblockers in patients with stable functional class II-III angina and frequency of attacks ≥3/week and HR>70 bpm. The use of ivabradine for 12 weeks allowed to achieve greater reduction of frequency of anginal attacks (by 4 per week, 95% confidence interval 3-6) compared with the group of usual care (treatment at physicians discretion). At the end of the study in ivabradine group 43% of patients had no angina at all, HR lowering ≤60 bpm was noted in 46% of patients (in the comparison group14 and 6%, respectively, p<0.001). Reduction of frequency of attacks of angina correlated with HR lowering, more with pulse rate measured by patients themselves (r=0.411, p<0.001), than with values measured at visits to physicians (r=0.266, p<0.001). Rate of lethal outcomes as well as rate of nonfatal cardiovascular complications (myocardial infarction, stroke, urgent revascularization) were similar in compared groups. In ivabradine group compared with usual care group there were less hospitalizations (5.0 and 8.6%, respectively, p=0.021), calls for emergency service (13.3 and 25.4%), and sick leaves (6.6 and 13.1%, p=0.018). Adverse reactions were noted in 130 patients (8.7%) in ivabradine group and in 29 patients (10.0%) in usual care group p=0.580).