[Beta-blockaders in first-intention treatment of exercise angina pectoris]

Effort angina may be treated with nitrates, beta-blockers or calcium antagonists which are equally effective. The choice of the appropriate treatment sometimes depends on clinical data, on the contraindications indications specific to each therapeutic class or on side-effects. In most cases, beta-blockers should be preferred since their side-effects are rare provided their contra-indications are respected, they are easy to administer and above all, they exert a protective effect on the heart demonstrated after myocardial infection and highly probable in angina. The possible occurrence, during prolonged treatment, of unstable angina or myocardial infarction--both conditions in which beta-blockers alone or combined with other drugs have been shown to be effective--is in favour of this treatment. However, the frequent presence of a vasomotor factor in the different clinical forms of coronary disease justifies the use of vasodilators concurrently with beta-blockers, notably in patients with severe angina.