Optimum treatment of stable angina pectoris.

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