Calcium antagonists for chronic stable angina pectoris.

Stable angina pectoris classically occurs on exertion or in response to other well-defined stress, and can be treated successfully, both in regard to symptoms and ability to undertake more exertion, with available calcium antagonists. Numerous reports suggest that response to calcium antagonists is similar to that with beta-adrenergic blockers, although the latter tend to show somewhat greater efficacy. Advantages in favor of calcium antagonists include the relative freedom from side effects that may occur with beta-adrenergic antagonists; the 2 types of substances can be combined usefully and given to the vast majority of patients requiring medication for angina. Left ventricular failure is a relative contraindication to both calcium antagonists and beta-adrenergic blockers, and thus to the combination. With calcium antagonists, however, the negative inotropic effects are often balanced by the associated peripheral vasodilatation. Where medical management of chronic stable angina is considered, calcium antagonists offer a reasonable alternative to beta blockers, and the use of the combination is highly effective, more so than either substance alone.