OPTIMUM TREATMENT OF STABLE ANGINA-PECTORIS

From a therapeutic point of view, angina pectoris is best thought of a s an imbalance between oxygen supply and demand. Oxygen supply to the heart can be increased by improving endothelial function to increase v asodilation. Non-endothelial-mediated vasodilation will also help incr ease coronary flow. Coronary vasodilators, such as the calcium blocker s and nitrates, are effective agents in relieving vasoconstriction and improving coronary blood flow Reduction of oxygen demand is accomplis hed by decreasing heart rate, blood pressure, heart size, and left ven tricular mass. Beta-blockers and heart rate-lowering calcium entry blo ckers are effective in reducing oxygen demand. Additive effects occur by combining a beta-blocker and a dihydropyridine calcium entry blocke r. Together with reduction of risk factors, this combination therapy p lus aspirin provides optimal management of patients with angina pector is.