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Clinical Use of Beta-Blockers and Calcium-Entry Blockers in Stable Angina Pectoris

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Selected Topics in Preventive Cardiology

Part of the book series: Ettore Majorana International Science Series ((SIPC))

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Summary

Drug therapy of coronary artery disease (CAD) is intended to eliminate the disproportion between oxygen supply and demand. Available drugs act mainly by reducing myocardial work and thus oxygen consumption. Some drugs antagonize the coronary spasm, thereby decreasing coronary resistance and, in consequence, increasing coronary blood flow.

Three classes of drugs have proved effective in the therapy of CAD: nitrates, S-blockers and calcium-entry blockers. The magnitude of oxygen consumption by the heart is determined by preload, afterload, heart rate and contractility. Nitrates, S-blockers and calcium-entry blockers reduce myocardial work while exerting fundamentally different effects on the cardiovascular system. Nitrates lower the preload, possess coronary dilating properties, can produce a more homogeneous pattern of coronary blood flow and, to a lesser extent, lower the afterload. S-blockers have a pronounced effect on the myocardium (reduce heart rate and contractility) and decrease blood pressure. They reduce coronary blood flow and do not antagonize coronary spasm. Calcium-entry blockers primarily lower the afterload, antagonize the coronary spasm and produce a more homogeneous coronary blood flow.

The treatment of CAD should be individualized: factors such type of symptoms, age, concomitant diseases and occupation influence the choice of the therapy.

In selected patients, nitrates, S-blockers and calcium-entry blockers can be combined, especially when there is arterial hypertension. Calcium-entry blockers are a heterogeneous class of drugs so that the choice of a given agent is not irrelevant. Nifedipine is more often combined with the S-blockers because it lacks electrophysiological effects. In contrast, verapamil may impair the sinus node function and prolongs the atrio-ventricular conduction. for this reason, there is a risk of precipitating bradycardia and/or heart failure by using verapamil together with a S-blocker. This combination is, therefore, rarely used.

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Author information

Authors and Affiliations

  1. Faculty of Internal Medicine, University of Basle, Switzerland

    Giuseppe Cocco

  2. Department of Cardiology, General Medical Clinics and Therapeutics University of Ferrara, Italy

    Barbara Leishman, Raffaele Pansini & Carlo Strozzi

Authors
  1. Giuseppe Cocco
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  2. Barbara Leishman
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  3. Raffaele Pansini
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  4. Carlo Strozzi
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Editor information

Editors and Affiliations

  1. University of Palermo Medical Center, Palermo, Italy

    Angelo Raineri

  2. The Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Jan J. Kellermann

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© 1983 Plenum Press, New York

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Cocco, G., Leishman, B., Pansini, R., Strozzi, C. (1983). Clinical Use of Beta-Blockers and Calcium-Entry Blockers in Stable Angina Pectoris. In: Raineri, A., Kellermann, J.J. (eds) Selected Topics in Preventive Cardiology. Ettore Majorana International Science Series. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3736-2_26

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  • DOI: https://doi.org/10.1007/978-1-4613-3736-2_26

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-3738-6

  • Online ISBN: 978-1-4613-3736-2

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