Mono- or combination therapy for stable angina pectoris

Symptom-limited exercise testing (SLET) makes it possible to appraise in a reproducible manner both the extent of ischemia and the circulatory profile. Therefore, repeated SLET with either one or another drug, or a combination of both allows a proper comparison and avoids the quite impractical trials lasting several weeks, far too complicated in the case of combination of drugs. From the knowledge of the components of myocardial oxygen demand and of the pharmacological properties of different drugs, it is easy to predict what combinations will be complementary, harmful, or redundant. The application of these principles to the individual patient is made easier by the determination of the circulatory profile and of the severity of ischemia. From that, the logical proposal for whichever combination is obvious. The more effective and less costly combination appears to be the association of beta 1-selective blockers and preventive sublingual nitroglycerin. beta-Blockers and nifedipine and diltiazem and molsidomine are also effective and well tolerated.