PHARMACOLOGICAL TREATMENT OF ISCHEMIC-HEART-DISEASE - MONOTHERAPY VS COMBINATION THERAPY

Non-invasive treatment continues to be the mainstay of anti-ischaemic therapy. The imbalance between myocardial oxygen supply and demand pro vides the basis for myocardial ischaemia, which may present as symptom atic, asymptomatic or, in most cases, a mixture of the two. Both sympt omatic and silent ischaemia are major prognostic indicators in patient s with coronary artery disease and treatment should therefore be direc ted towards both the amelioration of symptoms and the resolution of th e signs of ischaemia. Anti-ischaemic therapy map decrease oxygen deman d, increase myocardial oxygen supply, or both. Interventional therapie s, such as percutaneous transluminal coronary angioplasty and bypass g rafting, improve supply but do not alter demand. Drug therapy is assoc iated with a variety of effects upon both supply and demand, depending upon the agent used. Nitrates alter both myocardial oxygen supply and demand, while beta-blockers decrease myocardial oxygen demand. Calciu m channel blockers reduce after-load and myocardial contractility and, thus, lower oxygen demand, while the coronary artery relaxation that occurs in response to their use acts to increase supply. The use of co mbination therapy is considered by many to be the most rational approa ch to the treatment of myocardial ischaemia, in that it allows maximal reduction in demand and increase in supply.