Pharmacologic therapy of angina pectoris

The primary drugs utilized in the treatment of angina pectoris include organic nitrates, beta-adrenoceptor antagonists, Ca2+ antagonists, and the antithrombotic agents aspirin and heparin. Not all of these drugs are useful in every form of angina, and treatment is symptomatic rather than curative. In stable effort angina, beta-blockers, Ca2+ antagonists, and organic nitrates provide relief from angina pain and improve exercise tolerance primarily through their ability to decrease oxygen demand. The antiplatelet action of aspirin may decrease the incidence of myocardial infarction in these patients. Ca2+ channel blockers and organic nitrates are the drugs of choice for variant angina. These vasodilators restore blood flow by relieving the coronary vasospasm that triggers the ischemic episode. In unstable angina, aspirin and heparin reduce the risk of myocardial infarction, and aspirin increases survival. Heparin and nitrates alleviate angina pain, and under some circumstances beta-blockers and Ca2+ antagonists have a role in the relief of pain.