Our function is unbiased review and dissemination of therapeutic evidence. We are committed to evaluate the effectiveness of our educational activities using the Pharmacare database without identifying individual physicians, pharmacies or patients. There are 3 classes of drugs which are effective in the symptomatic management of angina pectoris. These 3 classes are nitrates, beta-blockers, and Ca channel blockers. There is increasing evidence that beta-blockers are the drug of first choice in the management of angina.
Beta blockers are at least as effective as the other two classes in controlling symptoms.
Beta blockers have also been shown to decrease the risk of adverse cardiac events in patients with angina and silent ischemia. Long acting nitrates work well in combination with beta blockers and are the obvious second choice. Daily doses may be timed according to the patient's symptoms. For daytime dosing no ISDN or any other long acting nitrate should be given after 5 pm. If nitrates are administered around the clock, tolerance to their effects develops rapidly.