The drugs most frequently used in the treatment of stable angina pectoris are the nitrates, the beta blockers, and the calcium channel blockers. Some authorities feel that no one agent can adequately control significant angina, and initiate treatment using two or more different agents. Selecting which drug to employ and in what dosage depends on the severity of the angina and associated conditions. For routine patients with no other problems, a good regimen would be a nitrate and a beta blocker. Some patients do not respond to the nitrates and beta blockers, and some do not tolerate nitrates or beta blockers because of side effects, so calcium channel blockers are added or sub-stituted respectively.
Some physicians prefer to start the patient on calcium channel blockers as initial therapy.
Some patients may require all three medications, and occasionally combinations of calcium channel blockers are used. Transluminal coronary angioplasty has become an accepted method of treating selected patients with angina due to atheromatous coronary artery disease. This procedure is particular-ly useful in patients with single or double vessel disease, especially for lesions of the left anterior descending coronary artery. A small percentage will fail to respond to medical management and will pro-ceed to myocardial infarction. Ano-ther small percentage will remain unstable with unremitting pain, and will require more aggressive management.